Surgical robotic systems with target trajectory deviation monitoring and related methods

ABSTRACT

A method may be provided to operate a surgical robotic system including a robotic arm configured to position a surgical end-effector with respect to an anatomical location of a patient. Position information may be received where the position information is generated using a sensor system remote from the robotic arm and remote from the patient. The position information may include position information relating to a tracking device affixed to the patient and position information relating to the surgical end-effector. The robotic arm may be controlled to move the surgical end-effector to a target trajectory relative to the anatomical location of the patient based on the position information generated using the sensor system.

This Application is a continuation-in-part application of U.S.application Ser. No. 15/609,334 filed on May 31, 2017, which is acontinuation-in-part of U.S. patent application Ser. No. 15/157,444,filed May 18, 2016, which is a continuation-in-part of U.S. patentapplication Ser. No. 15/095,883, filed Apr. 11, 2016, which is acontinuation-in-part of U.S. patent application Ser. No. 14/062,707,filed on Oct. 24, 2013, which is a continuation-in-part application ofU.S. patent application Ser. No. 13/924,505, filed on Jun. 21, 2013,which claims priority to provisional application No. 61/662,702 filed onJun. 21, 2012 and claims priority to provisional application No.61/800,527 filed on Mar. 15, 2013, all of which are incorporated byreference herein in their entireties for all purposes.

FIELD

The present disclosure relates to medical devices, and moreparticularly, surgical robotic systems and related methods and devices.

BACKGROUND

Position recognition systems for robot assisted surgeries are used todetermine the position of and track a particular object in 3-dimensions(3D). In robot assisted surgeries, for example, certain objects, such assurgical instruments, need to be tracked with a high degree of precisionas the instrument is being positioned and moved by a robot or by aphysician, for example.

Infrared signal based position recognition systems may use passiveand/or active sensors or markers for tracking the objects. In passivesensors or markers, objects to be tracked may include passive sensors,such as reflective spherical balls, which are positioned at strategiclocations on the object to be tracked. Infrared transmitters transmit asignal, and the reflective spherical balls reflect the signal to aid indetermining the position of the object in 3D. In active sensors ormarkers, the objects to be tracked include active infrared transmitters,such as light emitting diodes (LEDs), and thus generate their owninfrared signals for 3D detection.

With either active or passive tracking sensors, the system thengeometrically resolves the 3-dimensional position of the active and/orpassive sensors based on information from or with respect to one or moreof the infrared cameras, digital signals, known locations of the activeor passive sensors, distance, the time it took to receive the responsivesignals, other known variables, or a combination thereof.

These surgical systems can therefore utilize position feedback toprecisely guide movement of robotic arms and tools relative to apatients' surgical site. However, movement of the patient (e.g., due tobreathing) may affect the accuracy of the positioning.

SUMMARY

According to some embodiments of inventive concepts, a method may beprovided to operate a surgical robotic system including a robotic armconfigured to position a surgical end-effector with respect to ananatomical location of a patient. Position information may be received,with the position information being generated using a sensor systemremote from the robotic arm and remote from the patient. The positioninformation may include position information relating to a trackingdevice (e.g., a reference base or a dynamic reference base) affixed tothe patient and position information relating to the surgicalend-effector. The robotic arm may be controlled to move the surgicalend-effector to a target trajectory relative to the anatomical locationof the patient based on the position information generated using thesensor system. After controlling the robotic arm to move to the targettrajectory relative to the anatomical location of the patient,controlling the robotic arm to lock a position of the surgicalend-effector. While the position of the surgical end-effector is locked,a deviation between an actual trajectory of the surgical end-effectorwith respect to the anatomical location and a target trajectory of thesurgical end-effector with respect to the anatomical location may bedetermined. Moreover, the deviation may be determined based on thepositioning information generated using the sensor system after lockingthe position of the surgical end-effector. In addition, a user outputindicating the deviation may be generated responsive to determining thedeviation.

According to some other embodiments of inventive concepts, a method maybe provided to operate a surgical robotic system including a robotic armconfigured to position a surgical end-effector with respect to ananatomical location of a patient. Access may be provided to a model ofmovement of the anatomical location relative to a tracking device for aplurality of phases of a breathing cycle where the model provides aplurality of offsets of the anatomical location relative to the trackingdevice so that a respective one of the plurality of offsets isassociated with a respective one of the plurality of phases of thebreathing cycle. Position information may be generated using a sensorsystem remote from the robotic arm and remote from the patient. Theposition information may include information relating to positions ofthe tracking device affixed to the patient and positions of the surgicalend-effector as the tracking device moves due to the patient breathing.The plurality of phases of the breathing cycle may be detected as thetracking device moves due to the patient breathing. The robotic arm maybe controlled to maintain the surgical end-effector at a targettrajectory relative to the anatomical location of the patient as thetracking device moves due to the patient breathing. The controlling maybe based on receiving the position information, detecting the pluralityof phases, and using the plurality of offsets to determine locations ofthe anatomical location as the tracking device moves due to the patientbreathing.

According to still other embodiments of inventive concepts, a method maybe provided to operate a surgical robotic system including a robotic armconfigured to position a surgical end-effector with respect to ananatomical location of a patient. A model of movement of the anatomicallocation relative to a tracking device (e.g., a reference base or adynamic reference base) may be provided for a plurality of phases of abreathing cycle such that a first offset of the anatomical locationrelative to the tracking device is used to determine the targettrajectory for a first phase of a breathing cycle and a second offset ofthe anatomical location relative to the tracking device is used todetermine the target trajectory for a second phase of the breathingcycle. First position information may be received, with the firstposition information being generated using a sensor system remote fromthe robotic arm and remote from the patient. The first positioninformation may include information relating to a first position of atracking device affixed to the patient and a first position of thesurgical end-effector. The first phase of the breathing cycle of thepatient may be detected, and the robotic arm may be controlled to movethe surgical end-effector to a target trajectory relative to theanatomical location of the patient based on the first positioninformation and based on using the first offset to determine a firstlocation of the anatomical location from the first position of thetracking device responsive to detecting the first phase of the breathingcycle. Second position information generated using the sensor system maybe received, with the second position information including informationrelating to a second position of the tracking device affixed to thepatient and a second position of the surgical end-effector. The secondphase of the breathing cycle of the patient may be detected, and therobotic arm may be controlled to move the surgical end-effector tomaintain the target trajectory relative to the anatomical location ofthe patient based on the second position information and based on usingthe second offset to determine a second location of the anatomicallocation from the second position of the tracking device responsive todetecting the second phase of the breathing cycle.

Other methods and related surgical systems, and corresponding methodsand computer program products according to embodiments of the inventivesubject matter will be or become apparent to one with skill in the artupon review of the following drawings and detailed description. It isintended that all such surgical systems, and corresponding methods andcomputer program products be included within this description, be withinthe scope of the present inventive subject matter, and be protected bythe accompanying claims. Moreover, it is intended that all embodimentsdisclosed herein can be implemented separately or combined in any wayand/or combination.

DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide a furtherunderstanding of the disclosure and are incorporated in a constitute apart of this application, illustrate certain non-limiting embodiments ofinventive concepts. In the drawings:

FIG. 1 is an overhead view of a potential arrangement for locations ofthe robotic system, patient, surgeon, and other medical personnel duringa surgical procedure;

FIG. 2 illustrates the robotic system including positioning of thesurgical robot and the camera relative to the patient according to oneembodiment;

FIG. 3 illustrates a surgical robotic system in accordance with anexemplary embodiment;

FIG. 4 illustrates a portion of a surgical robot in accordance with anexemplary embodiment;

FIG. 5 illustrates a block diagram of a surgical robot in accordancewith an exemplary embodiment;

FIG. 6 illustrates a surgical robot in accordance with an exemplaryembodiment;

FIGS. 7A-7C illustrate an end-effector in accordance with an exemplaryembodiment;

FIG. 8 illustrates a surgical instrument and the end-effector, beforeand after, inserting the surgical instrument into the guide tube of theend-effector according to one embodiment;

FIGS. 9A-9C illustrate portions of an end-effector and robot arm inaccordance with an exemplary embodiment;

FIG. 10 illustrates a dynamic reference array, an imaging array, andother components in accordance with an exemplary embodiment;

FIG. 11 illustrates a method of registration in accordance with anexemplary embodiment;

FIG. 12A-12B illustrate embodiments of imaging devices according toexemplary embodiments;

FIG. 13A illustrates a portion of a robot including the robot arm and anend-effector in accordance with an exemplary embodiment;

FIG. 13B is a close-up view of the end-effector, with a plurality oftracking markers rigidly affixed thereon, shown in FIG. 13A;

FIG. 13C is a tool or instrument with a plurality of tracking markersrigidly affixed thereon according to one embodiment;

FIG. 14A is an alternative version of an end-effector with moveabletracking markers in a first configuration;

FIG. 14B is the end-effector shown in FIG. 14A with the moveabletracking markers in a second configuration;

FIG. 14C shows the template of tracking markers in the firstconfiguration from FIG. 14A;

FIG. 14D shows the template of tracking markers in the secondconfiguration from FIG. 14B;

FIG. 15A shows an alternative version of the end-effector having only asingle tracking marker affixed thereto;

FIG. 15B shows the end-effector of FIG. 15A with an instrument disposedthrough the guide tube;

FIG. 15C shows the end-effector of FIG. 15A with the instrument in twodifferent positions, and the resulting logic to determine if theinstrument is positioned within the guide tube or outside of the guidetube;

FIG. 15D shows the end-effector of FIG. 15A with the instrument in theguide tube at two different frames and its relative distance to thesingle tracking marker on the guide tube;

FIG. 15E shows the end-effector of FIG. 15A relative to a coordinatesystem;

FIG. 16 is a block diagram of a method for navigating and moving theend-effector of the robot to a desired target trajectory;

FIGS. 17A-17B depict an instrument for inserting an expandable implanthaving fixed and moveable tracking markers in contracted and expandedpositions, respectively;

FIGS. 18A-18B depict an instrument for inserting an articulating implanthaving fixed and moveable tracking markers in insertion and angledpositions, respectively;

FIG. 19A depicts an embodiment of a robot with interchangeable oralternative end-effectors;

FIG. 19B depicts an embodiment of a robot with an instrument styleend-effector coupled thereto;

FIGS. 20A, 20B, and 20C are schematic illustrations of meterconfigurations according to some embodiments of inventive concepts;

FIGS. 21A and 21B are schematic illustrations of trajectories atdifferent breathing phases according to some embodiments of inventiveconcepts;

FIG. 22 is a block diagram illustrating a robotic controller accordingto some embodiments of inventive concepts; and

FIGS. 23 and 24 are flow charts illustrating operations of surgicalrobotic systems according to some embodiments of inventive concepts.

DETAILED DESCRIPTION

It is to be understood that the present disclosure is not limited in itsapplication to the details of construction and the arrangement ofcomponents set forth in the description herein or illustrated in thedrawings. The teachings of the present disclosure may be used andpracticed in other embodiments and practiced or carried out in variousways. Also, it is to be understood that the phraseology and terminologyused herein is for the purpose of description and should not be regardedas limiting. The use of “including,” “comprising,” or “having” andvariations thereof herein is meant to encompass the items listedthereafter and equivalents thereof as well as additional items. Unlessspecified or limited otherwise, the terms “mounted,” “connected,”“supported,” and “coupled” and variations thereof are used broadly andencompass both direct and indirect mountings, connections, supports, andcouplings. Further, “connected” and “coupled” are not restricted tophysical or mechanical connections or couplings.

The following discussion is presented to enable a person skilled in theart to make and use embodiments of the present disclosure. Variousmodifications to the illustrated embodiments will be readily apparent tothose skilled in the art, and the principles herein can be applied toother embodiments and applications without departing from embodiments ofthe present disclosure. Thus, the embodiments are not intended to belimited to embodiments shown, but are to be accorded the widest scopeconsistent with the principles and features disclosed herein. Thefollowing detailed description is to be read with reference to thefigures, in which like elements in different figures have like referencenumerals. The figures, which are not necessarily to scale, depictselected embodiments and are not intended to limit the scope of theembodiments. Skilled artisans will recognize the examples providedherein have many useful alternatives and fall within the scope of theembodiments.

Turning now to the drawing, FIGS. 1 and 2 illustrate a surgical robotsystem 100 in accordance with an exemplary embodiment. Surgical robotsystem 100 may include, for example, a surgical robot 102, one or morerobot arms 104, a base 106, a display 110, an end-effector 112, forexample, including a guide tube 114, and one or more tracking markers118. The surgical robot system 100 may include a patient tracking device116 also including one or more tracking markers 118, which is adapted tobe secured directly to the patient 210 (e.g., to a bone of the patient210). The surgical robot system 100 may also use a camera 200, forexample, positioned on a camera stand 202. The camera stand 202 can haveany suitable configuration to move, orient, and support the camera 200in a desired position. The camera 200 may include any suitable camera orcameras, such as one or more infrared cameras (e.g., bifocal orstereophotogrammetric cameras), able to identify, for example, activeand passive tracking markers 118 (shown as part of patient trackingdevice 116 in FIG. 2 and shown by enlarged view in FIGS. 13A-13B) in agiven measurement volume viewable from the perspective of the camera200. The camera 200 may scan the given measurement volume and detect thelight that comes from the markers 118 in order to identify and determinethe position of the markers 118 in three-dimensions. For example, activemarkers 118 may include infrared-emitting markers that are activated byan electrical signal (e.g., infrared light emitting diodes (LEDs)),and/or passive markers 118 may include retro-reflective markers thatreflect infrared light (e.g., they reflect incoming IR radiation intothe direction of the incoming light), for example, emitted byilluminators on the camera 200 or other suitable device.

FIGS. 1 and 2 illustrate a potential configuration for the placement ofthe surgical robot system 100 in an operating room environment. Forexample, the robot 102 may be positioned near or next to patient 210.Although depicted near the head of the patient 210, it will beappreciated that the robot 102 can be positioned at any suitablelocation near the patient 210 depending on the area of the patient 210undergoing the operation. The camera 200 may be separated from the robotsystem 100 and positioned at the foot of patient 210. This locationallows the camera 200 to have a direct visual line of sight to thesurgical field 208. Again, it is contemplated that the camera 200 may belocated at any suitable position having line of sight to the surgicalfield 208. In the configuration shown, the surgeon 120 may be positionedacross from the robot 102, but is still able to manipulate theend-effector 112 and the display 110. A surgical assistant 126 may bepositioned across from the surgeon 120 again with access to both theend-effector 112 and the display 110. If desired, the locations of thesurgeon 120 and the assistant 126 may be reversed. The traditional areasfor the anesthesiologist 122 and the nurse or scrub tech 124 may remainunimpeded by the locations of the robot 102 and camera 200.

With respect to the other components of the robot 102, the display 110can be attached to the surgical robot 102 and in other exemplaryembodiments, display 110 can be detached from surgical robot 102, eitherwithin a surgical room with the surgical robot 102, or in a remotelocation. End-effector 112 may be coupled to the robot arm 104 andcontrolled by at least one motor. In exemplary embodiments, end-effector112 can comprise a guide tube 114, which is able to receive and orient asurgical instrument 608 (described further herein) used to performsurgery on the patient 210. As used herein, the term “end-effector” isused interchangeably with the terms “end-effectuator” and “effectuatorelement.” Although generally shown with a guide tube 114, it will beappreciated that the end-effector 112 may be replaced with any suitableinstrumentation suitable for use in surgery. In some embodiments,end-effector 112 can comprise any known structure for effecting themovement of the surgical instrument 608 in a desired manner.

The surgical robot 102 is able to control the translation andorientation of the end-effector 112. The robot 102 is able to moveend-effector 112 along x-, y-, and z-axes, for example. The end-effector112 can be configured for selective rotation about one or more of thex-, y-, and z-axis, and a Z Frame axis (such that one or more of theEuler Angles (e.g., roll, pitch, and/or yaw) associated withend-effector 112 can be selectively controlled). In some exemplaryembodiments, selective control of the translation and orientation ofend-effector 112 can permit performance of medical procedures withsignificantly improved accuracy compared to conventional robots thatuse, for example, a six degree of freedom robot arm comprising onlyrotational axes. For example, the surgical robot system 100 may be usedto operate on patient 210, and robot arm 104 can be positioned above thebody of patient 210, with end-effector 112 selectively angled relativeto the z-axis toward the body of patient 210.

In some exemplary embodiments, the position of the surgical instrument608 can be dynamically updated so that surgical robot 102 can be awareof the location of the surgical instrument 608 at all times during theprocedure. Consequently, in some exemplary embodiments, surgical robot102 can move the surgical instrument 608 to the desired position quicklywithout any further assistance from a physician (unless the physician sodesires). In some further embodiments, surgical robot 102 can beconfigured to correct the path of the surgical instrument 608 if thesurgical instrument 608 strays from the selected, preplanned trajectory.In some exemplary embodiments, surgical robot 102 can be configured topermit stoppage, modification, and/or manual control of the movement ofend-effector 112 and/or the surgical instrument 608. Thus, in use, inexemplary embodiments, a physician or other user can operate the system100, and has the option to stop, modify, or manually control theautonomous movement of end-effector 112 and/or the surgical instrument608. Further details of surgical robot system 100 including the controland movement of a surgical instrument 608 by surgical robot 102 can befound in co-pending U.S. patent application Ser. No. 13/924,505, whichis incorporated herein by reference in its entirety.

The robotic surgical system 100 can comprise one or more trackingmarkers 118 configured to track the movement of robot arm 104,end-effector 112, patient 210, and/or the surgical instrument 608 inthree dimensions. In exemplary embodiments, a plurality of trackingmarkers 118 can be mounted (or otherwise secured) thereon to an outersurface of the robot 102, such as, for example and without limitation,on base 106 of robot 102, on robot arm 104, and/or on the end-effector112. In exemplary embodiments, at least one tracking marker 118 of theplurality of tracking markers 118 can be mounted or otherwise secured tothe end-effector 112. One or more tracking markers 118 can further bemounted (or otherwise secured) to the patient 210. In exemplaryembodiments, the plurality of tracking markers 118 can be positioned onthe patient 210 spaced apart from the surgical field 208 to reduce thelikelihood of being obscured by the surgeon, surgical tools, or otherparts of the robot 102. Further, one or more tracking markers 118 can befurther mounted (or otherwise secured) to the surgical tools 608 (e.g.,a screw driver, dilator, implant inserter, or the like). Thus, thetracking markers 118 enable each of the marked objects (e.g., theend-effector 112, the patient 210, and the surgical tools 608) to betracked by the robot 102. In exemplary embodiments, system 100 can usetracking information collected from each of the marked objects tocalculate the orientation and location, for example, of the end-effector112, the surgical instrument 608 (e.g., positioned in the tube 114 ofthe end-effector 112), and the relative position of the patient 210.

The markers 118 may include radiopaque or optical markers. The markers118 may be suitably shaped include spherical, spheroid, cylindrical,cube, cuboid, or the like. In exemplary embodiments, one or more ofmarkers 118 may be optical markers. In some embodiments, the positioningof one or more tracking markers 118 on end-effector 112 can maximize theaccuracy of the positional measurements by serving to check or verifythe position of end-effector 112. Further details of surgical robotsystem 100 including the control, movement and tracking of surgicalrobot 102 and of a surgical instrument 608 can be found in U.S. patentpublication No. 2016/0242849, which is incorporated herein by referencein its entirety.

Exemplary embodiments include one or more markers 118 coupled to thesurgical instrument 608. In exemplary embodiments, these markers 118,for example, coupled to the patient 210 and surgical instruments 608, aswell as markers 118 coupled to the end-effector 112 of the robot 102 cancomprise conventional infrared light-emitting diodes (LEDs) or anOptotrak® diode capable of being tracked using a commercially availableinfrared optical tracking system such as Optotrak®. Optotrak® is aregistered trademark of Northern Digital Inc., Waterloo, Ontario,Canada. In other embodiments, markers 118 can comprise conventionalreflective spheres capable of being tracked using a commerciallyavailable optical tracking system such as Polaris Spectra. PolarisSpectra is also a registered trademark of Northern Digital, Inc. In anexemplary embodiment, the markers 118 coupled to the end-effector 112are active markers which comprise infrared light-emitting diodes whichmay be turned on and off, and the markers 118 coupled to the patient 210and the surgical instruments 608 comprise passive reflective spheres.

In exemplary embodiments, light emitted from and/or reflected by markers118 can be detected by camera 200 and can be used to monitor thelocation and movement of the marked objects. In alternative embodiments,markers 118 can comprise a radio-frequency and/or electromagneticreflector or transceiver and the camera 200 can include or be replacedby a radio-frequency and/or electromagnetic transceiver.

Similar to surgical robot system 100, FIG. 3 illustrates a surgicalrobot system 300 and camera stand 302, in a docked configuration,consistent with an exemplary embodiment of the present disclosure.Surgical robot system 300 may comprise a robot 301 including a display304, upper arm 306, lower arm 308, end-effector 310, vertical column312, casters 314, cabinet 316, tablet drawer 318, connector panel 320,control panel 322, and ring of information 324. Camera stand 302 maycomprise camera 326. These components are described in greater withrespect to FIG. 5. FIG. 3 illustrates the surgical robot system 300 in adocked configuration where the camera stand 302 is nested with the robot301, for example, when not in use. It will be appreciated by thoseskilled in the art that the camera 326 and robot 301 may be separatedfrom one another and positioned at any appropriate location during thesurgical procedure, for example, as shown in FIGS. 1 and 2.

FIG. 4 illustrates a base 400 consistent with an exemplary embodiment ofthe present disclosure. Base 400 may be a portion of surgical robotsystem 300 and comprise cabinet 316. Cabinet 316 may house certaincomponents of surgical robot system 300 including but not limited to abattery 402, a power distribution module 404, a platform interface boardmodule 406, a computer 408, a handle 412, and a tablet drawer 414. Theconnections and relationship between these components is described ingreater detail with respect to FIG. 5.

FIG. 5 illustrates a block diagram of certain components of an exemplaryembodiment of surgical robot system 300. Surgical robot system 300 maycomprise platform subsystem 502, computer subsystem 504, motion controlsubsystem 506, and tracking subsystem 532. Platform subsystem 502 mayfurther comprise battery 402, power distribution module 404, platforminterface board module 406, and tablet charging station 534. Computersubsystem 504 may further comprise computer 408, display 304, andspeaker 536. Motion control subsystem 506 may further comprise drivercircuit 508, motors 510, 512, 514, 516, 518, stabilizers 520, 522, 524,526, end-effector 310, and controller 538. Tracking subsystem 532 mayfurther comprise position sensor 540 and camera converter 542. System300 may also comprise a foot pedal 544 and tablet 546.

Input power is supplied to system 300 via a power source 548 which maybe provided to power distribution module 404. Power distribution module404 receives input power and is configured to generate different powersupply voltages that are provided to other modules, components, andsubsystems of system 300. Power distribution module 404 may beconfigured to provide different voltage supplies to platform interfacemodule 406, which may be provided to other components such as computer408, display 304, speaker 536, driver 508 to, for example, power motors512, 514, 516, 518 and end-effector 310, motor 510, ring 324, cameraconverter 542, and other components for system 300 for example, fans forcooling the electrical components within cabinet 316.

Power distribution module 404 may also provide power to other componentssuch as tablet charging station 534 that may be located within tabletdrawer 318. Tablet charging station 534 may be in wireless or wiredcommunication with tablet 546 for charging table 546. Tablet 546 may beused by a surgeon consistent with the present disclosure and describedherein.

Power distribution module 404 may also be connected to battery 402,which serves as temporary power source in the event that powerdistribution module 404 does not receive power from input power 548. Atother times, power distribution module 404 may serve to charge battery402 if necessary.

Other components of platform subsystem 502 may also include connectorpanel 320, control panel 322, and ring 324. Connector panel 320 mayserve to connect different devices and components to system 300 and/orassociated components and modules. Connector panel 320 may contain oneor more ports that receive lines or connections from differentcomponents. For example, connector panel 320 may have a ground terminalport that may ground system 300 to other equipment, a port to connectfoot pedal 544 to system 300, a port to connect to tracking subsystem532, which may comprise position sensor 540, camera converter 542, andcameras 326 associated with camera stand 302. Connector panel 320 mayalso include other ports to allow USB, Ethernet, HDMI communications toother components, such as computer 408.

Control panel 322 may provide various buttons or indicators that controloperation of system 300 and/or provide information regarding system 300.For example, control panel 322 may include buttons to power on or offsystem 300, lift or lower vertical column 312, and lift or lowerstabilizers 520-526 that may be designed to engage casters 314 to locksystem 300 from physically moving. Other buttons may stop system 300 inthe event of an emergency, which may remove all motor power and applymechanical brakes to stop all motion from occurring. Control panel 322may also have indicators notifying the user of certain system conditionssuch as a line power indicator or status of charge for battery 402.

Ring 324 may be a visual indicator to notify the user of system 300 ofdifferent modes that system 300 is operating under and certain warningsto the user.

Computer subsystem 504 includes computer 408, display 304, and speaker536. Computer 504 includes an operating system and software to operatesystem 300. Computer 504 may receive and process information from othercomponents (for example, tracking subsystem 532, platform subsystem 502,and/or motion control subsystem 506) in order to display information tothe user. Further, computer subsystem 504 may also include speaker 536to provide audio to the user.

Tracking subsystem 532 may include position sensor 504 and converter542. Tracking subsystem 532 may correspond to camera stand 302 includingcamera 326 as described with respect to FIG. 3. Position sensor 504 maybe camera 326. Tracking subsystem may track the location of certainmarkers that are located on the different components of system 300and/or instruments used by a user during a surgical procedure. Thistracking may be conducted in a manner consistent with the presentdisclosure including the use of infrared technology that tracks thelocation of active or passive elements, such as LEDs or reflectivemarkers, respectively. The location, orientation, and position ofstructures having these types of markers may be provided to computer 408which may be shown to a user on display 304. For example, a surgicalinstrument 608 having these types of markers and tracked in this manner(which may be referred to as a navigational space) may be shown to auser in relation to a three dimensional image of a patient's anatomicalstructure.

Motion control subsystem 506 may be configured to physically movevertical column 312, upper arm 306, lower arm 308, or rotateend-effector 310. The physical movement may be conducted through the useof one or more motors 510-518. For example, motor 510 may be configuredto vertically lift or lower vertical column 312. Motor 512 may beconfigured to laterally move upper arm 308 around a point of engagementwith vertical column 312 as shown in FIG. 3. Motor 514 may be configuredto laterally move lower arm 308 around a point of engagement with upperarm 308 as shown in FIG. 3. Motors 516 and 518 may be configured to moveend-effector 310 in a manner such that one may control the roll and onemay control the tilt, thereby providing multiple angles thatend-effector 310 may be moved. These movements may be achieved bycontroller 538 which may control these movements through load cellsdisposed on end-effector 310 and activated by a user engaging these loadcells to move system 300 in a desired manner.

Moreover, system 300 may provide for automatic movement of verticalcolumn 312, upper arm 306, and lower arm 308 through a user indicatingon display 304 (which may be a touchscreen input device) the location ofa surgical instrument or component on a three dimensional image of thepatient's anatomy on display 304. The user may initiate this automaticmovement by stepping on foot pedal 544 or some other input means.

FIG. 6 illustrates a surgical robot system 600 consistent with anexemplary embodiment. Surgical robot system 600 may compriseend-effector 602, robot arm 604, guide tube 606, instrument 608, androbot base 610. Instrument tool 608 may be attached to a tracking array612 including one or more tracking markers (such as markers 118) andhave an associated trajectory 614. Trajectory 614 may represent a pathof movement that instrument tool 608 is configured to travel once it ispositioned through or secured in guide tube 606, for example, a path ofinsertion of instrument tool 608 into a patient. In an exemplaryoperation, robot base 610 may be configured to be in electroniccommunication with robot arm 604 and end-effector 602 so that surgicalrobot system 600 may assist a user (for example, a surgeon) in operatingon the patient 210. Surgical robot system 600 may be consistent withpreviously described surgical robot system 100 and 300.

A tracking array 612 may be mounted on instrument 608 to monitor thelocation and orientation of instrument tool 608. The tracking array 612may be attached to an instrument 608 and may comprise tracking markers804. As best seen in FIG. 8, tracking markers 804 may be, for example,light emitting diodes and/or other types of reflective markers (e.g.,markers 118 as described elsewhere herein). The tracking devices may beone or more line of sight devices associated with the surgical robotsystem. As an example, the tracking devices may be one or more cameras200, 326 associated with the surgical robot system 100, 300 and may alsotrack tracking array 612 for a defined domain or relative orientationsof the instrument 608 in relation to the robot arm 604, the robot base610, end-effector 602, and/or the patient 210. The tracking devices maybe consistent with those structures described in connection with camerastand 302 and tracking subsystem 532.

FIGS. 7A, 7B, and 7C illustrate a top view, front view, and side view,respectively, of end-effector 602 consistent with an exemplaryembodiment. End-effector 602 may comprise one or more tracking markers702. Tracking markers 702 may be light emitting diodes or other types ofactive and passive markers, such as tracking markers 118 that have beenpreviously described. In an exemplary embodiment, the tracking markers702 are active infrared-emitting markers that are activated by anelectrical signal (e.g., infrared light emitting diodes (LEDs)). Thus,tracking markers 702 may be activated such that the infrared markers 702are visible to the camera 200, 326 or may be deactivated such that theinfrared markers 702 are not visible to the camera 200, 326. Thus, whenthe markers 702 are active, the end-effector 602 may be controlled bythe system 100, 300, 600, and when the markers 702 are deactivated, theend-effector 602 may be locked in position and unable to be moved by thesystem 100, 300, 600.

Markers 702 may be disposed on or within end-effector 602 in a mannersuch that the markers 702 are visible by one or more cameras 200, 326 orother tracking devices associated with the surgical robot system 100,300, 600. The camera 200, 326 or other tracking devices may trackend-effector 602 as it moves to different positions and viewing anglesby following the movement of tracking markers 702. The location ofmarkers 702 and/or end-effector 602 may be shown on a display 110, 304associated with the surgical robot system 100, 300, 600, for example,display 110 as shown in FIG. 2 and/or display 304 shown in FIG. 3. Thisdisplay 110, 304 may allow a user to ensure that end-effector 602 is ina desirable position in relation to robot arm 604, robot base 610, thepatient 210, and/or the user.

For example, as shown in FIG. 7A, markers 702 may be placed around thesurface of end-effector 602 so that a tracking device placed away fromthe surgical field 208 and facing toward the robot 102, 301 and thecamera 200, 326 is able to view at least 3 of the markers 702 through arange of common orientations of the end-effector 602 relative to thetracking device. For example, distribution of markers 702 in this wayallows end-effector 602 to be monitored by the tracking devices whenend-effector 602 is translated and rotated in the surgical field 208.

In addition, in exemplary embodiments, end-effector 602 may be equippedwith infrared (IR) receivers that can detect when an external camera200, 326 is getting ready to read markers 702. Upon this detection,end-effector 602 may then illuminate markers 702. The detection by theIR receivers that the external camera 200, 326 is ready to read markers702 may signal the need to synchronize a duty cycle of markers 702,which may be light emitting diodes, to an external camera 200, 326. Thismay also allow for lower power consumption by the robotic system as awhole, whereby markers 702 would only be illuminated at the appropriatetime instead of being illuminated continuously. Further, in exemplaryembodiments, markers 702 may be powered off to prevent interference withother navigation tools, such as different types of surgical instruments608.

FIG. 8 depicts one type of surgical instrument 608 including a trackingarray 612 and tracking markers 804. Tracking markers 804 may be of anytype described herein including but not limited to light emitting diodesor reflective spheres. Markers 804 are monitored by tracking devicesassociated with the surgical robot system 100, 300, 600 and may be oneor more of the line of sight cameras 200, 326. The cameras 200, 326 maytrack the location of instrument 608 based on the position andorientation of tracking array 612 and markers 804. A user, such as asurgeon 120, may orient instrument 608 in a manner so that trackingarray 612 and markers 804 are sufficiently recognized by the trackingdevice or camera 200, 326 to display instrument 608 and markers 804 on,for example, display 110 of the exemplary surgical robot system.

The manner in which a surgeon 120 may place instrument 608 into guidetube 606 of the end-effector 602 and adjust the instrument 608 isevident in FIG. 8. The hollow tube or guide tube 114, 606 of theend-effector 112, 310, 602 is sized and configured to receive at least aportion of the surgical instrument 608. The guide tube 114, 606 isconfigured to be oriented by the robot arm 104 such that insertion andtrajectory for the surgical instrument 608 is able to reach a desiredanatomical target within or upon the body of the patient 210. Thesurgical instrument 608 may include at least a portion of a generallycylindrical instrument. Although a screw driver is exemplified as thesurgical tool 608, it will be appreciated that any suitable surgicaltool 608 may be positioned by the end-effector 602. By way of example,the surgical instrument 608 may include one or more of a guide wire,cannula, a retractor, a drill, a reamer, a screw driver, an insertiontool, a removal tool, or the like. Although the hollow tube 114, 606 isgenerally shown as having a cylindrical configuration, it will beappreciated by those of skill in the art that the guide tube 114, 606may have any suitable shape, size and configuration desired toaccommodate the surgical instrument 608 and access the surgical site.

FIGS. 9A-9C illustrate end-effector 602 and a portion of robot arm 604consistent with an exemplary embodiment. End-effector 602 may furthercomprise body 1202 and clamp 1204. Clamp 1204 may comprise handle 1206,balls 1208, spring 1210, and lip 1212. Robot arm 604 may furthercomprise depressions 1214, mounting plate 1216, lip 1218, and magnets1220.

End-effector 602 may mechanically interface and/or engage with thesurgical robot system and robot arm 604 through one or more couplings.For example, end-effector 602 may engage with robot arm 604 through alocating coupling and/or a reinforcing coupling. Through thesecouplings, end-effector 602 may fasten with robot arm 604 outside aflexible and sterile barrier. In an exemplary embodiment, the locatingcoupling may be a magnetically kinematic mount and the reinforcingcoupling may be a five bar over center clamping linkage.

With respect to the locating coupling, robot arm 604 may comprisemounting plate 1216, which may be non-magnetic material, one or moredepressions 1214, lip 1218, and magnets 1220. Magnet 1220 is mountedbelow each of depressions 1214. Portions of clamp 1204 may comprisemagnetic material and be attracted by one or more magnets 1220. Throughthe magnetic attraction of clamp 1204 and robot arm 604, balls 1208become seated into respective depressions 1214. For example, balls 1208as shown in FIG. 9B would be seated in depressions 1214 as shown in FIG.9A. This seating may be considered a magnetically-assisted kinematiccoupling. Magnets 1220 may be configured to be strong enough to supportthe entire weight of end-effector 602 regardless of the orientation ofend-effector 602. The locating coupling may be any style of kinematicmount that uniquely restrains six degrees of freedom.

With respect to the reinforcing coupling, portions of clamp 1204 may beconfigured to be a fixed ground link and as such clamp 1204 may serve asa five bar linkage. Closing clamp handle 1206 may fasten end-effector602 to robot arm 604 as lip 1212 and lip 1218 engage clamp 1204 in amanner to secure end-effector 602 and robot arm 604. When clamp handle1206 is closed, spring 1210 may be stretched or stressed while clamp1204 is in a locked position. The locked position may be a position thatprovides for linkage past center. Because of a closed position that ispast center, the linkage will not open absent a force applied to clamphandle 1206 to release clamp 1204. Thus, in a locked positionend-effector 602 may be robustly secured to robot arm 604.

Spring 1210 may be a curved beam in tension. Spring 1210 may becomprised of a material that exhibits high stiffness and high yieldstrain such as virgin PEEK (poly-ether-ether-ketone). The linkagebetween end-effector 602 and robot arm 604 may provide for a sterilebarrier between end-effector 602 and robot arm 604 without impedingfastening of the two couplings.

The reinforcing coupling may be a linkage with multiple spring members.The reinforcing coupling may latch with a cam or friction basedmechanism. The reinforcing coupling may also be a sufficiently powerfulelectromagnet that will support fastening end-effector 102 to robot arm604. The reinforcing coupling may be a multi-piece collar completelyseparate from either end-effector 602 and/or robot arm 604 that slipsover an interface between end-effector 602 and robot arm 604 andtightens with a screw mechanism, an over center linkage, or a cammechanism.

Referring to FIGS. 10 and 11, prior to or during a surgical procedure,certain registration procedures may be conducted to track objects and atarget anatomical structure of the patient 210 both in a navigationspace and an image space. To conduct such registration, a registrationsystem 1400 may be used as illustrated in FIG. 10.

To track the position of the patient 210, a patient tracking device 116may include a patient fixation instrument 1402 to be secured to a rigidanatomical structure of the patient 210 and a dynamic reference base(DRB) 1404 may be securely attached to the patient fixation instrument1402. For example, patient fixation instrument 1402 may be inserted intoopening 1406 of dynamic reference base 1404. Dynamic reference base 1404may contain markers 1408 that are visible to tracking devices, such astracking subsystem 532. These markers 1408 may be optical markers orreflective spheres, such as tracking markers 118, as previouslydiscussed herein.

Patient fixation instrument 1402 is attached to a rigid anatomy of thepatient 210 and may remain attached throughout the surgical procedure.In an exemplary embodiment, patient fixation instrument 1402 is attachedto a rigid area of the patient 210, for example, a bone that is locatedaway from the targeted anatomical structure subject to the surgicalprocedure. In order to track the targeted anatomical structure, dynamicreference base 1404 is associated with the targeted anatomical structurethrough the use of a registration fixture that is temporarily placed onor near the targeted anatomical structure in order to register thedynamic reference base 1404 with the location of the targeted anatomicalstructure.

A registration fixture 1410 is attached to patient fixation instrument1402 through the use of a pivot arm 1412. Pivot arm 1412 is attached topatient fixation instrument 1402 by inserting patient fixationinstrument 1402 through an opening 1414 of registration fixture 1410.Pivot arm 1412 is attached to registration fixture 1410 by, for example,inserting a knob 1416 through an opening 1418 of pivot arm 1412.

Using pivot arm 1412, registration fixture 1410 may be placed over thetargeted anatomical structure and its location may be determined in animage space and navigation space using tracking markers 1420 and/orfiducials 1422 on registration fixture 1410. Registration fixture 1410may contain a collection of markers 1420 that are visible in anavigational space (for example, markers 1420 may be detectable bytracking subsystem 532). Tracking markers 1420 may be optical markersvisible in infrared light as previously described herein. Registrationfixture 1410 may also contain a collection of fiducials 1422, forexample, such as bearing balls, that are visible in an imaging space(for example, a three dimension CT image). As described in greaterdetail with respect to FIG. 11, using registration fixture 1410, thetargeted anatomical structure may be associated with dynamic referencebase 1404 thereby allowing depictions of objects in the navigationalspace to be overlaid on images of the anatomical structure. Dynamicreference base 1404, located at a position away from the targetedanatomical structure, may become a reference point thereby allowingremoval of registration fixture 1410 and/or pivot arm 1412 from thesurgical area.

FIG. 11 provides an exemplary method 1500 for registration consistentwith the present disclosure. Method 1500 begins at step 1502 wherein agraphical representation (or image(s)) of the targeted anatomicalstructure may be imported into system 100, 300 600, for example computer408. The graphical representation may be three dimensional CT or afluoroscope scan of the targeted anatomical structure of the patient 210which includes registration fixture 1410 and a detectable imagingpattern of fiducials 1420.

At step 1504, an imaging pattern of fiducials 1420 is detected andregistered in the imaging space and stored in computer 408. Optionally,at this time at step 1506, a graphical representation of theregistration fixture 1410 may be overlaid on the images of the targetedanatomical structure.

At step 1508, a navigational pattern of registration fixture 1410 isdetected and registered by recognizing markers 1420. Markers 1420 may beoptical markers that are recognized in the navigation space throughinfrared light by tracking subsystem 532 via position sensor 540. Thus,the location, orientation, and other information of the targetedanatomical structure is registered in the navigation space. Therefore,registration fixture 1410 may be recognized in both the image spacethrough the use of fiducials 1422 and the navigation space through theuse of markers 1420. At step 1510, the registration of registrationfixture 1410 in the image space is transferred to the navigation space.This transferal is done, for example, by using the relative position ofthe imaging pattern of fiducials 1422 compared to the position of thenavigation pattern of markers 1420.

At step 1512, registration of the navigation space of registrationfixture 1410 (having been registered with the image space) is furthertransferred to the navigation space of dynamic registration array 1404attached to patient fixture instrument 1402. Thus, registration fixture1410 may be removed and dynamic reference base 1404 may be used to trackthe targeted anatomical structure in both the navigation and image spacebecause the navigation space is associated with the image space.

At steps 1514 and 1516, the navigation space may be overlaid on theimage space and objects with markers visible in the navigation space(for example, surgical instruments 608 with optical markers 804). Theobjects may be tracked through graphical representations of the surgicalinstrument 608 on the images of the targeted anatomical structure.

FIGS. 12A-12B illustrate imaging devices 1304 that may be used inconjunction with robot systems 100, 300, 600 to acquire pre-operative,intra-operative, post-operative, and/or real-time image data of patient210. Any appropriate subject matter may be imaged for any appropriateprocedure using the imaging system 1304. The imaging system 1304 may beany imaging device such as imaging device 1306 and/or a C-arm 1308device. It may be desirable to take x-rays of patient 210 from a numberof different positions, without the need for frequent manualrepositioning of patient 210 which may be required in an x-ray system.As illustrated in FIG. 12A, the imaging system 1304 may be in the formof a C-arm 1308 that includes an elongated C-shaped member terminatingin opposing distal ends 1312 of the “C” shape. C-shaped member 1130 mayfurther comprise an x-ray source 1314 and an image receptor 1316. Thespace within C-arm 1308 of the arm may provide room for the physician toattend to the patient substantially free of interference from x-raysupport structure 1318. As illustrated in FIG. 12B, the imaging systemmay include imaging device 1306 having a gantry housing 1324 attached toa support structure imaging device support structure 1328, such as awheeled mobile cart 1330 with wheels 1332, which may enclose an imagecapturing portion, not illustrated. The image capturing portion mayinclude an x-ray source and/or emission portion and an x-ray receivingand/or image receiving portion, which may be disposed about one hundredand eighty degrees from each other and mounted on a rotor (notillustrated) relative to a track of the image capturing portion. Theimage capturing portion may be operable to rotate three hundred andsixty degrees during image acquisition. The image capturing portion mayrotate around a central point and/or axis, allowing image data ofpatient 210 to be acquired from multiple directions or in multipleplanes. Although certain imaging systems 1304 are exemplified herein, itwill be appreciated that any suitable imaging system may be selected byone of ordinary skill in the art.

Turning now to FIGS. 13A-13C, the surgical robot system 100, 300, 600relies on accurate positioning of the end-effector 112, 602, surgicalinstruments 608, and/or the patient 210 (e.g., patient tracking device116) relative to the desired surgical area. In the embodiments shown inFIGS. 13A-13C, the tracking markers 118, 804 are rigidly attached to aportion of the instrument 608 and/or end-effector 112.

FIG. 13A depicts part of the surgical robot system 100 with the robot102 including base 106, robot arm 104, and end-effector 112. The otherelements, not illustrated, such as the display, cameras, etc. may alsobe present as described herein. FIG. 13B depicts a close-up view of theend-effector 112 with guide tube 114 and a plurality of tracking markers118 rigidly affixed to the end-effector 112. In this embodiment, theplurality of tracking markers 118 are attached to the guide tube 112.FIG. 13C depicts an instrument 608 (in this case, a probe 608A) with aplurality of tracking markers 804 rigidly affixed to the instrument 608.As described elsewhere herein, the instrument 608 could include anysuitable surgical instrument, such as, but not limited to, guide wire,cannula, a retractor, a drill, a reamer, a screw driver, an insertiontool, a removal tool, or the like.

When tracking an instrument 608, end-effector 112, or other object to betracked in 3D, an array of tracking markers 118, 804 may be rigidlyattached to a portion of the tool 608 or end-effector 112. Preferably,the tracking markers 118, 804 are attached such that the markers 118,804 are out of the way (e.g., not impeding the surgical operation,visibility, etc.). The markers 118, 804 may be affixed to the instrument608, end-effector 112, or other object to be tracked, for example, withan array 612. Usually three or four markers 118, 804 are used with anarray 612. The array 612 may include a linear section, a cross piece,and may be asymmetric such that the markers 118, 804 are at differentrelative positions and locations with respect to one another. Forexample, as shown in FIG. 13C, a probe 608A with a 4-marker trackingarray 612 is shown, and FIG. 13B depicts the end-effector 112 with adifferent 4-marker tracking array 612.

In FIG. 13C, the tracking array 612 functions as the handle 620 of theprobe 608A. Thus, the four markers 804 are attached to the handle 620 ofthe probe 608A, which is out of the way of the shaft 622 and tip 624.Stereophotogrammetric tracking of these four markers 804 allows theinstrument 608 to be tracked as a rigid body and for the tracking system100, 300, 600 to precisely determine the position of the tip 624 and theorientation of the shaft 622 while the probe 608A is moved around infront of tracking cameras 200, 326.

To enable automatic tracking of one or more tools 608, end-effector 112,or other object to be tracked in 3D (e.g., multiple rigid bodies), themarkers 118, 804 on each tool 608, end-effector 112, or the like, arearranged asymmetrically with a known inter-marker spacing. The reasonfor asymmetric alignment is so that it is unambiguous which marker 118,804 corresponds to a particular location on the rigid body and whethermarkers 118, 804 are being viewed from the front or back, i.e.,mirrored. For example, if the markers 118, 804 were arranged in a squareon the tool 608 or end-effector 112, it would be unclear to the system100, 300, 600 which marker 118, 804 corresponded to which corner of thesquare. For example, for the probe 608A, it would be unclear whichmarker 804 was closest to the shaft 622. Thus, it would be unknown whichway the shaft 622 was extending from the array 612. Accordingly, eacharray 612 and thus each tool 608, end-effector 112, or other object tobe tracked should have a unique marker pattern to allow it to bedistinguished from other tools 608 or other objects being tracked.Asymmetry and unique marker patterns allow the system 100, 300, 600 todetect individual markers 118, 804 then to check the marker spacingagainst a stored template to determine which tool 608, end effector 112,or other object they represent. Detected markers 118, 804 can then besorted automatically and assigned to each tracked object in the correctorder. Without this information, rigid body calculations could not thenbe performed to extract key geometric information, for example, such astool tip 624 and alignment of the shaft 622, unless the user manuallyspecified which detected marker 118, 804 corresponded to which positionon each rigid body. These concepts are commonly known to those skilledin the methods of 3D optical tracking.

Turning now to FIGS. 14A-14D, an alternative version of an end-effector912 with moveable tracking markers 918A-918D is shown. In FIG. 14A, anarray with moveable tracking markers 918A-918D are shown in a firstconfiguration, and in FIG. 14B the moveable tracking markers 918A-918Dare shown in a second configuration, which is angled relative to thefirst configuration. FIG. 14C shows the template of the tracking markers918A-918D, for example, as seen by the cameras 200, 326 in the firstconfiguration of FIG. 14A; and FIG. 14D shows the template of trackingmarkers 918A-918D, for example, as seen by the cameras 200, 326 in thesecond configuration of FIG. 14B.

In this embodiment, 4-marker array tracking is contemplated wherein themarkers 918A-918D are not all in fixed position relative to the rigidbody and instead, one or more of the array markers 918A-918D can beadjusted, for example, during testing, to give updated information aboutthe rigid body that is being tracked without disrupting the process forautomatic detection and sorting of the tracked markers 918A-918D.

When tracking any tool, such as a guide tube 914 connected to the endeffector 912 of a robot system 100, 300, 600, the tracking array'sprimary purpose is to update the position of the end effector 912 in thecamera coordinate system. When using the rigid system, for example, asshown in FIG. 13B, the array 612 of reflective markers 118 rigidlyextend from the guide tube 114. Because the tracking markers 118 arerigidly connected, knowledge of the marker locations in the cameracoordinate system also provides exact location of the centerline, tip,and tail of the guide tube 114 in the camera coordinate system.Typically, information about the position of the end effector 112 fromsuch an array 612 and information about the location of a targettrajectory from another tracked source are used to calculate therequired moves that must be input for each axis of the robot 102 thatwill move the guide tube 114 into alignment with the trajectory and movethe tip to a particular location along the trajectory vector.

Sometimes, the desired trajectory is in an awkward or unreachablelocation, but if the guide tube 114 could be swiveled, it could bereached. For example, a very steep trajectory pointing away from thebase 106 of the robot 102 might be reachable if the guide tube 114 couldbe swiveled upward beyond the limit of the pitch (wrist up-down angle)axis, but might not be reachable if the guide tube 114 is attachedparallel to the plate connecting it to the end of the wrist. To reachsuch a trajectory, the base 106 of the robot 102 might be moved or adifferent end effector 112 with a different guide tube attachment mightbe exchanged with the working end effector. Both of these solutions maybe time consuming and cumbersome.

As best seen in FIGS. 14A and 14B, if the array 908 is configured suchthat one or more of the markers 918A-918D are not in a fixed positionand instead, one or more of the markers 918A-918D can be adjusted,swiveled, pivoted, or moved, the robot 102 can provide updatedinformation about the object being tracked without disrupting thedetection and tracking process. For example, one of the markers918A-918D may be fixed in position and the other markers 918A-918D maybe moveable; two of the markers 918A-918D may be fixed in position andthe other markers 918A-918D may be moveable; three of the markers918A-918D may be fixed in position and the other marker 918A-918D may bemoveable; or all of the markers 918A-918D may be moveable.

In the embodiment shown in FIGS. 14A and 14B, markers 918A, 918 B arerigidly connected directly to a base 906 of the end-effector 912, andmarkers 918C, 918D are rigidly connected to the tube 914. Similar toarray 612, array 908 may be provided to attach the markers 918A-918D tothe end-effector 912, instrument 608, or other object to be tracked. Inthis case, however, the array 908 is comprised of a plurality ofseparate components. For example, markers 918A, 918B may be connected tothe base 906 with a first array 908A, and markers 918C, 918D may beconnected to the guide tube 914 with a second array 908B. Marker 918Amay be affixed to a first end of the first array 908A and marker 918Bmay be separated a linear distance and affixed to a second end of thefirst array 908A. While first array 908 is substantially linear, secondarray 908B has a bent or V-shaped configuration, with respective rootends, connected to the guide tube 914, and diverging therefrom to distalends in a V-shape with marker 918C at one distal end and marker 918D atthe other distal end. Although specific configurations are exemplifiedherein, it will be appreciated that other asymmetric designs includingdifferent numbers and types of arrays 908A, 908B and differentarrangements, numbers, and types of markers 918A-918D are contemplated.

The guide tube 914 may be moveable, swivelable, or pivotable relative tothe base 906, for example, across a hinge 920 or other connector to thebase 906. Thus, markers 918C, 918D are moveable such that when the guidetube 914 pivots, swivels, or moves, markers 918C, 918D also pivot,swivel, or move. As best seen in FIG. 14A, guide tube 914 has alongitudinal axis 916 which is aligned in a substantially normal orvertical orientation such that markers 918A-918D have a firstconfiguration. Turning now to FIG. 14B, the guide tube 914 is pivoted,swiveled, or moved such that the longitudinal axis 916 is now angledrelative to the vertical orientation such that markers 918A-918D have asecond configuration, different from the first configuration.

In contrast to the embodiment described for FIGS. 14A-14D, if a swivelexisted between the guide tube 914 and the arm 104 (e.g., the wristattachment) with all four markers 918A-918D remaining attached rigidlyto the guide tube 914 and this swivel was adjusted by the user, therobotic system 100, 300, 600 would not be able to automatically detectthat the guide tube 914 orientation had changed. The robotic system 100,300, 600 would track the positions of the marker array 908 and wouldcalculate incorrect robot axis moves assuming the guide tube 914 wasattached to the wrist (the robot arm 104) in the previous orientation.By keeping one or more markers 918A-918D (e.g., two markers 918C, 918D)rigidly on the tube 914 and one or more markers 918A-918D (e.g., twomarkers 918A, 918B) across the swivel, automatic detection of the newposition becomes possible and correct robot moves are calculated basedon the detection of a new tool or end-effector 112, 912 on the end ofthe robot arm 104.

One or more of the markers 918A-918D are configured to be moved,pivoted, swiveled, or the like according to any suitable means. Forexample, the markers 918A-918D may be moved by a hinge 920, such as aclamp, spring, lever, slide, toggle, or the like, or any other suitablemechanism for moving the markers 918A-918D individually or incombination, moving the arrays 908A, 908B individually or incombination, moving any portion of the end-effector 912 relative toanother portion, or moving any portion of the tool 608 relative toanother portion.

As shown in FIGS. 14A and 14B, the array 908 and guide tube 914 maybecome reconfigurable by simply loosening the clamp or hinge 920, movingpart of the array 908A, 908B relative to the other part 908A, 908B, andretightening the hinge 920 such that the guide tube 914 is oriented in adifferent position. For example, two markers 918C, 918D may be rigidlyinterconnected with the tube 914 and two markers 918A, 918B may berigidly interconnected across the hinge 920 to the base 906 of theend-effector 912 that attaches to the robot arm 104. The hinge 920 maybe in the form of a clamp, such as a wing nut or the like, which can beloosened and retightened to allow the user to quickly switch between thefirst configuration (FIG. 14A) and the second configuration (FIG. 14B).

The cameras 200, 326 detect the markers 918A-918D, for example, in oneof the templates identified in FIGS. 14C and 14D. If the array 908 is inthe first configuration (FIG. 14A) and tracking cameras 200, 326 detectthe markers 918A-918D, then the tracked markers match Array Template 1as shown in FIG. 14C. If the array 908 is the second configuration (FIG.14B) and tracking cameras 200, 326 detect the same markers 918A-918D,then the tracked markers match Array Template 2 as shown in FIG. 14D.Array Template 1 and Array Template 2 are recognized by the system 100,300, 600 as two distinct tools, each with its own uniquely definedspatial relationship between guide tube 914, markers 918A-918D, androbot attachment. The user could therefore adjust the position of theend-effector 912 between the first and second configurations withoutnotifying the system 100, 300, 600 of the change and the system 100,300, 600 would appropriately adjust the movements of the robot 102 tostay on trajectory.

In this embodiment, there are two assembly positions in which the markerarray matches unique templates that allow the system 100, 300, 600 torecognize the assembly as two different tools or two different endeffectors. In any position of the swivel between or outside of these twopositions (namely, Array Template 1 and Array Template 2 shown in FIGS.14C and 14D, respectively), the markers 918A-918D would not match anytemplate and the system 100, 300, 600 would not detect any array presentdespite individual markers 918A-918D being detected by cameras 200, 326,with the result being the same as if the markers 918A-918D weretemporarily blocked from view of the cameras 200, 326. It will beappreciated that other array templates may exist for otherconfigurations, for example, identifying different instruments 608 orother end-effectors 112, 912, etc.

In the embodiment described, two discrete assembly positions are shownin FIGS. 14A and 14B. It will be appreciated, however, that there couldbe multiple discrete positions on a swivel joint, linear joint,combination of swivel and linear joints, pegboard, or other assemblywhere unique marker templates may be created by adjusting the positionof one or more markers 918A-918D of the array relative to the others,with each discrete position matching a particular template and defininga unique tool 608 or end-effector 112, 912 with different knownattributes. In addition, although exemplified for end effector 912, itwill be appreciated that moveable and fixed markers 918A-918D may beused with any suitable instrument 608 or other object to be tracked.

When using an external 3D tracking system 100, 300, 600 to track a fullrigid body array of three or more markers attached to a robot's endeffector 112 (for example, as depicted in FIGS. 13A and 13B), it ispossible to directly track or to calculate the 3D position of everysection of the robot 102 in the coordinate system of the cameras 200,326. The geometric orientations of joints relative to the tracker areknown by design, and the linear or angular positions of joints are knownfrom encoders for each motor of the robot 102, fully defining the 3Dpositions of all of the moving parts from the end effector 112 to thebase 116. Similarly, if a tracker were mounted on the base 106 of therobot 102 (not shown), it is likewise possible to track or calculate the3D position of every section of the robot 102 from base 106 to endeffector 112 based on known joint geometry and joint positions from eachmotor's encoder.

In some situations, it may be desirable to track the positions of allsegments of the robot 102 from fewer than three markers 118 rigidlyattached to the end effector 112. Specifically, if a tool 608 isintroduced into the guide tube 114, it may be desirable to track fullrigid body motion of the robot 902 with only one additional marker 118being tracked.

Turning now to FIGS. 15A-15E, an alternative version of an end-effector1012 having only a single tracking marker 1018 is shown. End-effector1012 may be similar to the other end-effectors described herein, and mayinclude a guide tube 1014 extending along a longitudinal axis 1016. Asingle tracking marker 1018, similar to the other tracking markersdescribed herein, may be rigidly affixed to the guide tube 1014. Thissingle marker 1018 can serve the purpose of adding missing degrees offreedom to allow full rigid body tracking and/or can serve the purposeof acting as a surveillance marker to ensure that assumptions aboutrobot and camera positioning are valid.

The single tracking marker 1018 may be attached to the robotic endeffector 1012 as a rigid extension to the end effector 1012 thatprotrudes in any convenient direction and does not obstruct thesurgeon's view. The tracking marker 1018 may be affixed to the guidetube 1014 or any other suitable location of on the end-effector 1012.When affixed to the guide tube 1014, the tracking marker 1018 may bepositioned at a location between first and second ends of the guide tube1014. For example, in FIG. 15A, the single tracking marker 1018 is shownas a reflective sphere mounted on the end of a narrow shaft 1017 thatextends forward from the guide tube 1014 and is positionedlongitudinally above a mid-point of the guide tube 1014 and below theentry of the guide tube 1014. This position allows the marker 1018 to begenerally visible by cameras 200, 326 but also would not obstruct visionof the surgeon 120 or collide with other tools or objects in thevicinity of surgery. In addition, the guide tube 1014 with the marker1018 in this position is designed for the marker array on any tool 608introduced into the guide tube 1014 to be visible at the same time asthe single marker 1018 on the guide tube 1014 is visible.

As shown in FIG. 15B, when a snugly fitting tool or instrument 608 isplaced within the guide tube 1014, the instrument 608 becomesmechanically constrained in 4 of 6 degrees of freedom. That is, theinstrument 608 cannot be rotated in any direction except about thelongitudinal axis 1016 of the guide tube 1014 and the instrument 608cannot be translated in any direction except along the longitudinal axis1016 of the guide tube 1014. In other words, the instrument 608 can onlybe translated along and rotated about the centerline of the guide tube1014. If two more parameters are known, such as (1) an angle of rotationabout the longitudinal axis 1016 of the guide tube 1014; and (2) aposition along the guide tube 1014, then the position of the endeffector 1012 in the camera coordinate system becomes fully defined.

Referring now to FIG. 15C, the system 100, 300, 600 should be able toknow when a tool 608 is actually positioned inside of the guide tube1014 and is not instead outside of the guide tube 1014 and justsomewhere in view of the cameras 200, 326. The tool 608 has alongitudinal axis or centerline 616 and an array 612 with a plurality oftracked markers 804. The rigid body calculations may be used todetermine where the centerline 616 of the tool 608 is located in thecamera coordinate system based on the tracked position of the array 612on the tool 608.

The fixed normal (perpendicular) distance D_(F) from the single marker1018 to the centerline or longitudinal axis 1016 of the guide tube 1014is fixed and is known geometrically, and the position of the singlemarker 1018 can be tracked. Therefore, when a detected distance D_(D)from tool centerline 616 to single marker 1018 matches the known fixeddistance D_(F) from the guide tube centerline 1016 to the single marker1018, it can be determined that the tool 608 is either within the guidetube 1014 (centerlines 616, 1016 of tool 608 and guide tube 1014coincident) or happens to be at some point in the locus of possiblepositions where this distance D_(D) matches the fixed distance D_(F).For example, in FIG. 15C, the normal detected distance D_(D) from toolcenterline 616 to the single marker 1018 matches the fixed distanceD_(F) from guide tube centerline 1016 to the single marker 1018 in bothframes of data (tracked marker coordinates) represented by thetransparent tool 608 in two positions, and thus, additionalconsiderations may be needed to determine when the tool 608 is locatedin the guide tube 1014.

Turning now to FIG. 15D, programmed logic can be used to look for framesof tracking data in which the detected distance D_(D) from toolcenterline 616 to single marker 1018 remains fixed at the correct lengthdespite the tool 608 moving in space by more than some minimum distancerelative to the single sphere 1018 to satisfy the condition that thetool 608 is moving within the guide tube 1014. For example, a firstframe F1 may be detected with the tool 608 in a first position and asecond frame F2 may be detected with the tool 608 in a second position(namely, moved linearly with respect to the first position). The markers804 on the tool array 612 may move by more than a given amount (e.g.,more than 5 mm total) from the first frame F1 to the second frame F2.Even with this movement, the detected distance D_(D) from the toolcenterline vector C′ to the single marker 1018 is substantiallyidentical in both the first frame F1 and the second frame F2.

Logistically, the surgeon 120 or user could place the tool 608 withinthe guide tube 1014 and slightly rotate it or slide it down into theguide tube 1014 and the system 100, 300, 600 would be able to detectthat the tool 608 is within the guide tube 1014 from tracking of thefive markers (four markers 804 on tool 608 plus single marker 1018 onguide tube 1014). Knowing that the tool 608 is within the guide tube1014, all 6 degrees of freedom may be calculated that define theposition and orientation of the robotic end effector 1012 in space.Without the single marker 1018, even if it is known with certainty thatthe tool 608 is within the guide tube 1014, it is unknown where theguide tube 1014 is located along the tool's centerline vector C′ and howthe guide tube 1014 is rotated relative to the centerline vector C′.

With emphasis on FIG. 15E, the presence of the single marker 1018 beingtracked as well as the four markers 804 on the tool 608, it is possibleto construct the centerline vector C′ of the guide tube 1014 and tool608 and the normal vector through the single marker 1018 and through thecenterline vector C′. This normal vector has an orientation that is in aknown orientation relative to the forearm of the robot distal to thewrist (in this example, oriented parallel to that segment) andintersects the centerline vector C′ at a specific fixed position. Forconvenience, three mutually orthogonal vectors k′, j′, i′ can beconstructed, as shown in FIG. 15E, defining rigid body position andorientation of the guide tube 1014. One of the three mutually orthogonalvectors k′ is constructed from the centerline vector C′, the secondvector j′ is constructed from the normal vector through the singlemarker 1018, and the third vector i′ is the vector cross product of thefirst and second vectors k′, j′. The robot's joint positions relative tothese vectors k′, j′, i′ are known and fixed when all joints are atzero, and therefore rigid body calculations can be used to determine thelocation of any section of the robot relative to these vectors k′, j′,i′ when the robot is at a home position. During robot movement, if thepositions of the tool markers 804 (while the tool 608 is in the guidetube 1014) and the position of the single marker 1018 are detected fromthe tracking system, and angles/linear positions of each joint are knownfrom encoders, then position and orientation of any section of the robotcan be determined.

In some embodiments, it may be useful to fix the orientation of the tool608 relative to the guide tube 1014. For example, the end effector guidetube 1014 may be oriented in a particular position about its axis 1016to allow machining or implant positioning. Although the orientation ofanything attached to the tool 608 inserted into the guide tube 1014 isknown from the tracked markers 804 on the tool 608, the rotationalorientation of the guide tube 1014 itself in the camera coordinatesystem is unknown without the additional tracking marker 1018 (ormultiple tracking markers in other embodiments) on the guide tube 1014.This marker 1018 provides essentially a “clock position” from −180° to+180° based on the orientation of the marker 1018 relative to thecenterline vector C′. Thus, the single marker 1018 can provideadditional degrees of freedom to allow full rigid body tracking and/orcan act as a surveillance marker to ensure that assumptions about therobot and camera positioning are valid.

FIG. 16 is a block diagram of a method 1100 for navigating and movingthe end-effector 1012 (or any other end-effector described herein) ofthe robot 102 to a desired target trajectory. Another use of the singlemarker 1018 on the robotic end effector 1012 or guide tube 1014 is aspart of the method 1100 enabling the automated safe movement of therobot 102 without a full tracking array attached to the robot 102. Thismethod 1100 functions when the tracking cameras 200, 326 do not moverelative to the robot 102 (i.e., they are in a fixed position), thetracking system's coordinate system and robot's coordinate system areco-registered, and the robot 102 is calibrated such that the positionand orientation of the guide tube 1014 can be accurately determined inthe robot's Cartesian coordinate system based only on the encodedpositions of each robotic axis.

For this method 1100, the coordinate systems of the tracker and therobot must be co-registered, meaning that the coordinate transformationfrom the tracking system's Cartesian coordinate system to the robot'sCartesian coordinate system is needed. For convenience, this coordinatetransformation can be a 4×4 matrix of translations and rotations that iswell known in the field of robotics. This transformation will be termedTcr to refer to “transformation—camera to robot”. Once thistransformation is known, any new frame of tracking data, which isreceived as x,y,z coordinates in vector form for each tracked marker,can be multiplied by the 4×4 matrix and the resulting x,y,z coordinateswill be in the robot's coordinate system. To obtain Tcr, a full trackingarray on the robot is tracked while it is rigidly attached to the robotat a location that is known in the robot's coordinate system, then knownrigid body methods are used to calculate the transformation ofcoordinates. It should be evident that any tool 608 inserted into theguide tube 1014 of the robot 102 can provide the same rigid bodyinformation as a rigidly attached array when the additional marker 1018is also read. That is, the tool 608 need only be inserted to anyposition within the guide tube 1014 and at any rotation within the guidetube 1014, not to a fixed position and orientation. Thus, it is possibleto determine Tcr by inserting any tool 608 with a tracking array 612into the guide tube 1014 and reading the tool's array 612 plus thesingle marker 1018 of the guide tube 1014 while at the same timedetermining from the encoders on each axis the current location of theguide tube 1014 in the robot's coordinate system.

Logic for navigating and moving the robot 102 to a target trajectory isprovided in the method 1100 of FIG. 16. Before entering the loop 1102,it is assumed that the transformation Tcr was previously stored. Thus,before entering loop 1102, in step 1104, after the robot base 106 issecured, greater than or equal to one frame of tracking data of a toolinserted in the guide tube while the robot is static is stored; and instep 1106, the transformation of robot guide tube position from cameracoordinates to robot coordinates Tcr is calculated from this static dataand previous calibration data. Tcr should remain valid as long as thecameras 200, 326 do not move relative to the robot 102. If the cameras200, 326 move relative to the robot 102, and Tcr needs to bere-obtained, the system 100, 300, 600 can be made to prompt the user toinsert a tool 608 into the guide tube 1014 and then automaticallyperform the necessary calculations.

In the flowchart of method 1100, each frame of data collected consistsof the tracked position of the DRB 1404 on the patient 210, the trackedposition of the single marker 1018 on the end effector 1014, and asnapshot of the positions of each robotic axis. From the positions ofthe robot's axes, the location of the single marker 1018 on the endeffector 1012 is calculated. This calculated position is compared to theactual position of the marker 1018 as recorded from the tracking system.If the values agree, it can be assured that the robot 102 is in a knownlocation. The transformation Tcr is applied to the tracked position ofthe DRB 1404 so that the target for the robot 102 can be provided interms of the robot's coordinate system. The robot 102 can then becommanded to move to reach the target.

After steps 1104, 1106, loop 1102 includes step 1108 receiving rigidbody information for DRB 1404 from the tracking system; step 1110transforming target tip and trajectory from image coordinates totracking system coordinates; and step 1112 transforming target tip andtrajectory from camera coordinates to robot coordinates (apply Tcr).Loop 1102 further includes step 1114 receiving a single stray markerposition for robot from tracking system; and step 1116 transforming thesingle stray marker from tracking system coordinates to robotcoordinates (apply stored Tcr). Loop 1102 also includes step 1118determining current location of the single robot marker 1018 in therobot coordinate system from forward kinematics. The information fromsteps 1116 and 1118 is used to determine step 1120 whether the straymarker coordinates from transformed tracked position agree with thecalculated coordinates being less than a given tolerance. If yes,proceed to step 1122, calculate and apply robot move to target x, y, zand trajectory. If no, proceed to step 1124, halt and require full arrayinsertion into guide tube 1014 before proceeding; step 1126 after arrayis inserted, recalculate Tcr; and then proceed to repeat steps 1108,1114, and 1118.

This method 1100 has advantages over a method in which the continuousmonitoring of the single marker 1018 to verify the location is omitted.Without the single marker 1018, it would still be possible to determinethe position of the end effector 1012 using Tcr and to send theend-effector 1012 to a target location but it would not be possible toverify that the robot 102 was actually in the expected location. Forexample, if the cameras 200, 326 had been bumped and Tcr was no longervalid, the robot 102 would move to an erroneous location. For thisreason, the single marker 1018 provides value with regard to safety.

For a given fixed position of the robot 102, it is theoreticallypossible to move the tracking cameras 200, 326 to a new location inwhich the single tracked marker 1018 remains unmoved since it is asingle point, not an array. In such a case, the system 100, 300, 600would not detect any error since there would be agreement in thecalculated and tracked locations of the single marker 1018. However,once the robot's axes caused the guide tube 1012 to move to a newlocation, the calculated and tracked positions would disagree and thesafety check would be effective.

The term “surveillance marker” may be used, for example, in reference toa single marker that is in a fixed location relative to the DRB 1404. Inthis instance, if the DRB 1404 is bumped or otherwise dislodged, therelative location of the surveillance marker changes and the surgeon 120can be alerted that there may be a problem with navigation. Similarly,in the embodiments described herein, with a single marker 1018 on therobot's guide tube 1014, the system 100, 300, 600 can continuously checkwhether the cameras 200, 326 have moved relative to the robot 102. Ifregistration of the tracking system's coordinate system to the robot'scoordinate system is lost, such as by cameras 200, 326 being bumped ormalfunctioning or by the robot malfunctioning, the system 100, 300, 600can alert the user and corrections can be made. Thus, this single marker1018 can also be thought of as a surveillance marker for the robot 102.

It should be clear that with a full array permanently mounted on therobot 102 (e.g., the plurality of tracking markers 702 on end-effector602 shown in FIGS. 7A-7C) such functionality of a single marker 1018 asa robot surveillance marker is not needed because it is not requiredthat the cameras 200, 326 be in a fixed position relative to the robot102, and Tcr is updated at each frame based on the tracked position ofthe robot 102. Reasons to use a single marker 1018 instead of a fullarray are that the full array is more bulky and obtrusive, therebyblocking the surgeon's view and access to the surgical field 208 morethan a single marker 1018, and line of sight to a full array is moreeasily blocked than line of sight to a single marker 1018.

Turning now to FIGS. 17A-17B and 18A-18B, instruments 608, such asimplant holders 608B, 608C, are depicted which include both fixed andmoveable tracking markers 804, 806. The implant holders 608B, 608C mayhave a handle 620 and an outer shaft 622 extending from the handle 620.The shaft 622 may be positioned substantially perpendicular to thehandle 620, as shown, or in any other suitable orientation. An innershaft 626 may extend through the outer shaft 622 with a knob 628 at oneend. Implant 10, 12 connects to the shaft 622, at the other end, at tip624 of the implant holder 608B, 608C using typical connection mechanismsknown to those of skill in the art. The knob 628 may be rotated, forexample, to expand or articulate the implant 10, 12. U.S. Pat. Nos.8,709,086 and 8,491,659, which are incorporated by reference herein,describe expandable fusion devices and methods of installation.

When tracking the tool 608, such as implant holder 608B, 608C, thetracking array 612 may contain a combination of fixed markers 804 andone or more moveable markers 806 which make up the array 612 or isotherwise attached to the implant holder 608B, 608C. The navigationarray 612 may include at least one or more (e.g., at least two) fixedposition markers 804, which are positioned with a known locationrelative to the implant holder instrument 608B, 608C. These fixedmarkers 804 would not be able to move in any orientation relative to theinstrument geometry and would be useful in defining where the instrument608 is in space. In addition, at least one marker 806 is present whichcan be attached to the array 612 or the instrument itself which iscapable of moving within a pre-determined boundary (e.g., sliding,rotating, etc.) relative to the fixed markers 804. The system 100, 300,600 (e.g., the software) correlates the position of the moveable marker806 to a particular position, orientation, or other attribute of theimplant 10 (such as height of an expandable interbody spacer shown inFIGS. 17A-17B or angle of an articulating interbody spacer shown inFIGS. 18A-18B). Thus, the system and/or the user can determine theheight or angle of the implant 10, 12 based on the location of themoveable marker 806.

In the embodiment shown in FIGS. 17A-17B, four fixed markers 804 areused to define the implant holder 608B and a fifth moveable marker 806is able to slide within a pre-determined path to provide feedback on theimplant height (e.g., a contracted position or an expanded position).FIG. 17A shows the expandable spacer 10 at its initial height, and FIG.17B shows the spacer 10 in the expanded state with the moveable marker806 translated to a different position. In this case, the moveablemarker 806 moves closer to the fixed markers 804 when the implant 10 isexpanded, although it is contemplated that this movement may be reversedor otherwise different. The amount of linear translation of the marker806 would correspond to the height of the implant 10. Although only twopositions are shown, it would be possible to have this as a continuousfunction whereby any given expansion height could be correlated to aspecific position of the moveable marker 806.

Turning now to FIGS. 18A-18B, four fixed markers 804 are used to definethe implant holder 608C and a fifth, moveable marker 806 is configuredto slide within a pre-determined path to provide feedback on the implantarticulation angle. FIG. 18A shows the articulating spacer 12 at itsinitial linear state, and FIG. 18B shows the spacer 12 in an articulatedstate at some offset angle with the moveable marker 806 translated to adifferent position. The amount of linear translation of the marker 806would correspond to the articulation angle of the implant 12. Althoughonly two positions are shown, it would be possible to have this as acontinuous function whereby any given articulation angle could becorrelated to a specific position of the moveable marker 806.

In these embodiments, the moveable marker 806 slides continuously toprovide feedback about an attribute of the implant 10, 12 based onposition. It is also contemplated that there may be discreet positionsthat the moveable marker 806 must be in which would also be able toprovide further information about an implant attribute. In this case,each discreet configuration of all markers 804, 806 correlates to aspecific geometry of the implant holder 608B, 608C and the implant 10,12 in a specific orientation or at a specific height. In addition, anymotion of the moveable marker 806 could be used for other variableattributes of any other type of navigated implant.

Although depicted and described with respect to linear movement of themoveable marker 806, the moveable marker 806 should not be limited tojust sliding as there may be applications where rotation of the marker806 or other movements could be useful to provide information about theimplant 10, 12. Any relative change in position between the set of fixedmarkers 804 and the moveable marker 806 could be relevant informationfor the implant 10, 12 or other device. In addition, although expandableand articulating implants 10, 12 are exemplified, the instrument 608could work with other medical devices and materials, such as spacers,cages, plates, fasteners, nails, screws, rods, pins, wire structures,sutures, anchor clips, staples, stents, bone grafts, biologics, cements,or the like.

Turning now to FIG. 19A, it is envisioned that the robot end-effector112 is interchangeable with other types of end-effectors 112. Moreover,it is contemplated that each end-effector 112 may be able to perform oneor more functions based on a desired surgical procedure. For example,the end-effector 112 having a guide tube 114 may be used for guiding aninstrument 608 as described herein. In addition, end-effector 112 may bereplaced with a different or alternative end-effector 112 that controlsa surgical device, instrument, or implant, for example.

The alternative end-effector 112 may include one or more devices orinstruments coupled to and controllable by the robot. By way ofnon-limiting example, the end-effector 112, as depicted in FIG. 19A, maycomprise a retractor (for example, one or more retractors disclosed inU.S. Pat. Nos. 8,992,425 and 8,968,363) or one or more mechanisms forinserting or installing surgical devices such as expandableintervertebral fusion devices (such as expandable implants exemplifiedin U.S. Pat. Nos. 8,845,734; 9,510,954; and 9,456,903), stand-aloneintervertebral fusion devices (such as implants exemplified in U.S. Pat.Nos. 9,364,343 and 9,480,579), expandable corpectomy devices (such ascorpectomy implants exemplified in U.S. Pat. Nos. 9,393,128 and9,173,747), articulating spacers (such as implants exemplified in U.S.Pat. No. 9,259,327), facet prostheses (such as devices exemplified inU.S. Pat. No. 9,539,031), laminoplasty devices (such as devicesexemplified in U.S. Pat. No. 9,486,253), spinous process spacers (suchas implants exemplified in U.S. Pat. No. 9,592,082), inflatables,fasteners including polyaxial screws, uniplanar screws, pedicle screws,posted screws, and the like, bone fixation plates, rod constructs andrevision devices (such as devices exemplified in U.S. Pat. No.8,882,803), artificial and natural discs, motion preserving devices andimplants, spinal cord stimulators (such as devices exemplified in U.S.Pat. No. 9,440,076), and other surgical devices. The end-effector 112may include one or instruments directly or indirectly coupled to therobot for providing bone cement, bone grafts, living cells,pharmaceuticals, or other deliverable to a surgical target. Theend-effector 112 may also include one or more instruments designed forperforming a discectomy, kyphoplasty, vertebrostenting, dilation, orother surgical procedure.

The end-effector itself and/or the implant, device, or instrument mayinclude one or more markers 118 such that the location and position ofthe markers 118 may be identified in three-dimensions. It iscontemplated that the markers 118 may include active or passive markers118, as described herein, that may be directly or indirectly visible tothe cameras 200. Thus, one or more markers 118 located on an implant 10,for example, may provide for tracking of the implant 10 before, during,and after implantation.

As shown in FIG. 19B, the end-effector 112 may include an instrument 608or portion thereof that is coupled to the robot arm 104 (for example,the instrument 608 may be coupled to the robot arm 104 by the couplingmechanism shown in FIGS. 9A-9C) and is controllable by the robot system100. Thus, in the embodiment shown in FIG. 19B, the robot system 100 isable to insert implant 10 into a patient and expand or contract theexpandable implant 10. Accordingly, the robot system 100 may beconfigured to assist a surgeon or to operate partially or completelyindependently thereof. Thus, it is envisioned that the robot system 100may be capable of controlling each alternative end-effector 112 for itsspecified function or surgical procedure.

Although the robot and associated systems described herein are generallydescribed with reference to spine applications, it is also contemplatedthat the robot system is configured for use in other surgicalapplications, including but not limited to, surgeries in trauma or otherorthopedic applications (such as the placement of intramedullary nails,plates, and the like), cranial, neuro, cardiothoracic, vascular,colorectal, oncological, dental, and other surgical operations andprocedures.

During robotic spine (or other) procedures, a Dynamic Reference Base(DRB) may thus be affixed to the patient (e.g., to a bone of thepatient), and used to track the patient anatomy. Since the patient isbreathing, a position of the DRB (which is attached to the patient'sbody) may oscillate. The position of the end-effector's affixed guidetube may be robotically automatically controlled to stay aligned withthe target trajectory continuously during these oscillations. However,once a surgical tool is introduced into the guide tube, the automaticposition control may cease for safety reasons and the robotic willremain rigidly fixed in a static pose. Henceforth, patient movement(e.g., due to breathing) may cause deviation from the target trajectorywhile the end-effector (e.g., surgical tool) remain locked in placerelative to the room. This deviation/shift (if unnoticed and unaccountedfor) may thus reduce accuracy of the system and/or surgical procedure.

According to some embodiments of inventive concepts, detection ofpatient movement (e.g., due to breathing) may be improved, and/orpositioning may be improved. For example, information from a remotesensor system may be used to generate a representation of the effect ofbreathing relative to positioning of a robotic end-effector. Suchdeviation may be monitored based on a deviation (difference) between anactual end-effector trajectory and a target (i.e., planned) end-effecttrajectory, for example, used for placement of a spinal screw (or othermedical device/implant/procedure). If patient breathing is significant,the resulting deviation may cause a distance of the actual trajectory ofthe end-effector from the target (planned) trajectory to vary. Accordingto some embodiments of inventive concepts, this deviation may beprovided on display 110. According to some embodiments, a graphic metermay be shown on display 110 with three distinct sections. These sectionsmay be colored to indicate an extent of the shift: green, yellow, andred. In a procedure during which breathing is considered excessive, auser (e.g., a surgeon) may request that the anesthesiologist limit theamount of breathing, or halt the patient breathing entirely for a shortperiod to facilitate a more accurate placement of the end-effector.

FIGS. 20A, 20B, and 20C illustrate three embodiments of a breathingmeter structure that may be provided as a graphic meter on display 110.In FIG. 20A, the meter may be illustrated using a rounded dialconfiguration with a “needle” 2001 a indicating the degree of deviation.In FIG. 20B, the meter may be illustrated using a horizontal barconfiguration with “needle” 2001 b indicating the degree of deviation.In FIG. 20C, the meter may be illustrated using a vertical barconfiguration with “needle” 2001 c indicating the degree of deviation.In any of the embodiments of FIGS. 20A-C, the “needle” may be omittedwith illumination being used to indicate the degree of deviation. Forexample, the green areas (or portions thereof) may be illuminated(without illuminating yellow and red areas) to indicate degrees of lowdeviations; the green areas and yellow areas (or portions of the yellowareas) may be illuminated (without illuminating red areas) to indicatedegrees of medium deviation; and the green areas, yellow areas, and redareas (or portions of the red areas) may be illuminated to indicatedegrees of high deviation. Moreover, the meter may be used todynamically indicate a changing deviation in real-time (e.g., due tobreathing).

In addition or in an alternative, the surgical robotic system mayindicate when the end-effector's position should be updated to reduce asteady-state error created by the deviation to the plan position usingthe meter or other visual or audio output. For example, because the DRBis affixed to the patient, the meter may reflect a steady-statedeviation from the target trajectory resulting from movement of thepatient on the operative bed. Providing this information to the user(e.g., surgeon or other member of the surgical team) may allow the userto choose when to activate the robotic arm to reduce the steady-statedeviation (i.e., to close the feedback loop).

Because not all people breathe in the same manner or with the sameintensity, magnitudes of deviations between actual and targettrajectories may vary greatly between different patients. Moreover, adesired deviation between target and actual trajectories of theend-effector (considered to be an optimal deviation of zero) may beindicated at the green end of the meter, and an extreme deviationbetween target and actual trajectories of the end-effector may beindicated at the red end of the meter. Moreover, a difference betweendesired and extreme deviations may result from DRB movements of only oneto two millimeters.

The meter may thus be used to indicate real-time deviations betweenactual and target trajectories of the end-effector (e.g., caused byperiodic movement due to breathing, and/or one-time movement such as ashifting of the patient's body). This displayed deviation may afford theuser (e.g., the surgeon or other surgical team member) an awareness torobotically move the end-effector to the target trajectory and allowsettling to a precise target (planned) position defined by the targettrajectory of the end-effector. By using the DRB to track movement,should use of any instrument cause a significant shift in patientposition, the meter would indicate the change, thus notifying the userto robotically move the end-effector to the target trajectory once more,thereby reducing deviation between the actual and target trajectoriesuntil any such deviation is within acceptable limits.

According to some embodiments, the surgical robotic system may usefeedback from remote sensors (e.g., tracking cameras 200) to determinepositions of the DRB and the robotic arm end-effector, and a fixedoffset may be used to determine a particular anatomical location of thepatient relative to the DRB provided that a position of the DRB relativeto the anatomical location is substantially fixed. For example, if theDRB is affixed to the spine and the anatomical location is a location onthe spine for placement of a screw, a position of the DRB relative tothe anatomical location may be substantially fixed (even if as the spinemoves due to breathing) so that a fixed offset may be used to determinethe anatomical location based on the location of the DRB during allphases of breathing.

According to some other embodiments, an offset between the DRB and theanatomical location may be variable. For example, if the DRB is affixedto the spine and the anatomical location is in soft tissue (e.g., anorgan such as a lung) spaced apart from the DRB, an offset between theDRB and the anatomical location may change over different phases of thebreathing cycle. In such cases, the position of the DRB cannot be usedexclusively to track the targeted anatomy. The surgical robotic systemmay using modeling to provide a variable offset used to determine aposition of the target anatomical location based on a position of theDRB during different phases of the breathing cycle.

According to some embodiments of inventive concepts, a meter of FIGS.20A, 20B, and/or 20C and/or a determination of deviation between targetand actual trajectories of an end-effector may be used to provideenhanced robotic guidance during procedures that may be affected bybreathing, such as a lung or organ biopsy or other soft tissueprocedure. If the movement of a lesion to be biopsied is not fixedrelative to movement of the DRB during breathing as shown in FIGS. 21Aand 21B (i.e., an offset between the DRB and the lesion is variable overthe breathing cycle), then a mathematical or experimental prediction ofan offset of the target needle trajectory relative to the location ofattachment of the DRB at various phases of breathing may be useful. Forexample, an offset between the DRB and the lesion when the lungs aredeflated as shown in FIG. 21A may be different than an offset betweenthe DRB and the lesion when the lungs are inflated as shown in FIG. 21B.Such predictions may be based on tissue modeling and/or modeledestimations of where different portions of the lung move duringbreathing. That is, by studying how lungs generally behave during eachphase of breathing, a computational model may be created to provide thelocation of any lung location throughout the breathing cycle. The modelmay then be applied to a specific patient with a lesion at a specificlocation. In an alternative, the path of lesion movement may beexperimentally acquired for a patient by taking x-rays or other types ofimaging while simultaneously recording breathing phase. Data framescould be compiled that contain an image together with a breathing phase,and a lookup table or fitted mathematical formula of lesion offsets vs.phase may be created and referenced later during the surgical procedureto guide the robotic arm positioning the end-effector. This informationcan be used to determine offsets of the DRB relative to the lesion atthe different phases of breathing so that knowledge of the position ofthe DRB can be used to determine a corresponding position of the lesionover the different phases of breathing.

FIG. 21A (with deflated lungs) and FIG. 21B (with inflated lungs) areschematic illustrations of a torso from an axial perspective, showingeffect of breathing on DRB vs. lesion spatial position. In this example,a magnitude and direction of movement of the bone to which the DRB isattached may be different than a magnitude and direction of movement ofthe lung lesion so that tracking the lesion based on a fixed offset fromthe DRB may be insufficient to accurately track the location of thelesion. Although the position of the lung lesion cannot be directlytracked during different phases of breathing, a position of the lunglesion relative to the anchor point of the DRB can be modeled orotherwise determined and a robot guide tube (or other end-effector)position may be adjusted so that its trajectory intersects the actuallesion location during multiple/all phases of lung inflation/deflation.

Functionally, the robotic system may track the DRB directly as the basecoordinates and then adjust the position of the guide tube for softtissue biopsy based on the lookup table or mathematical model ofvariable offsets (i.e., positional offsets) and the phase position ofbreathing. In one embodiment, the robotic system may adjust its positioncontinuously and automatically based on the tracked breathing, so thatat any time the surgeon can deploy the biopsy needle and accuratelytarget the lesion. In another embodiment, the robot could hold steady ata position corresponding to a particular phase and then indicate to theuser through a meter (e.g., a meter of FIGS. 20A, 20B, and/or 20C) whenthe biopsy needle is in appropriate position for manual deployment bythe surgeon. The surgeon would watch the meter and deploy the biopsyneedle when appropriate. In another embodiment, the robotic system couldhold steady at a position corresponding to a particular phase and alsoautomatically deploy the biopsy needle at the proper time without manualintervention from the surgeon.

Embodiments of inventive concepts may thus be used to aid a surgeon indetermining how much to limit a patient breathing level to compensatefor or reduce/eliminate shifts in the DRB and/or trajectory of anend-effector on a robotic arm. Moreover, a graphic meter may be used toshow deviation between actual and target trajectories due to the use ofan instrument in the end-effector guide tube causing a shift of the DRB.Furthermore, modeling of variable offsets may be used to more accuratelydetermine a position of an anatomical location relative to a DRB insituations where a positional offset between the DRB and the anatomicallocation (e.g., lesion) changes over the different phases of breathing.For example, a first offset may be used to determine the position of theanatomical location based on the position of the DRB during a firstphase of breathing (e.g., deflated), and a second offset may be used todetermine the position of the anatomical location based on the positionof the DRB during a second phase of breathing (e.g., inflated). Thisinformation can thus be used by the surgical robotic system to:automatically and continuously position/reposition the end-effector overthe breathing cycle to maintain the end-effector on the targettrajectory with respect to a moving anatomical location (e.g., lesion);and/or to automatically deploy a surgical tool from the end-effectorwhen properly aligned on the target trajectory with respect to theanatomical location (e.g., lesion).

FIG. 22 is a block diagram illustrating elements of a surgical roboticsystem controller (e.g., implemented within computer 408). As shown, thecontroller may include processor circuit 2207 (also referred to as aprocessor) coupled with input interface circuit 2201 (also referred toas an input interface), output interface circuit 2203 (also referred toas an output interface), control interface circuit 2205 (also referredto as a control interface), and memory circuit 2209 (also referred to asa memory). The memory circuit 2209 may include computer readable programcode that when executed by the processor circuit 2207 causes theprocessor circuit to perform operations according to embodimentsdisclosed herein. According to other embodiments, processor circuit 2207may be defined to include memory so that a separate memory circuit isnot required.

As discussed herein, operations of wireless terminal UE may be performedby processor 2207, input interface 2201, output interface 2203, and/orcontrol interface 2205. For example, processor 2207 may receive userinput through input interface 2201, and such user input may include userinput received through foot pedal 544, tablet 546, etc. Processor 2207may also receive position sensor input received from tracking system 532and/or cameras 200 through input interface 2201. Processor 2207 mayprovide output through output interface 2203, and such out may includeinformation to render graphic/visual information on display 304 and/oraudio output to be provided through speaker 536. Processor 2207 mayprovide robotic control information through control interface 2205 tomotion control subsystem 506, and the robotic control information may beused to control operation of robot arm 104 (also referred to as arobotic arm) and/or end-effector 112.

Operations of a surgical robotic system (including a robotic armconfigured to position a surgical end-effector with respect to ananatomical location of a patient) will now be discussed with referenceto the flow chart of FIG. 23 according to some embodiments of inventiveconcepts. For example, modules may be stored in memory 2209 of FIG. 22,and these modules may provide instructions so that when the instructionsof a module are executed by processor 2207, processor 2207 performsrespective operations of the flow chart of FIG. 23.

At block 2301, processor 2207 may receive user input (e.g., input from asurgeon or other member of the surgical team) through input interface2201 to move the surgical end-effector to a target trajectory relativeto an anatomical location of the patient. The target trajectory may be aposition and/or alignment of the end-effector relative to the anatomicallocation used to perform a surgical procedure. Moreover, the user inputmay be provided via an input device such as foot pedal 544 that is“normally-off” such that active input from the user is required to allowmotion of the robotic arm 104 used to position the end-effector 112. Inthe example of a foot pedal, for example, the user may be required toactively press the foot pedal to allow motion of the robotic arm and/orend-effector, and positions of the robotic arm and end-effector may belocked when the user is not actively pressing the foot pedal.

At block 2303, processor 2207 may receive position information generatedusing a sensor system (e.g., camera system 200) remote from the roboticarm 104 and remote from the patient. The position information may bereceived through input interface 2201. The position information mayinclude position information relating to a tracking device (e.g., areference base or a dynamic reference base DRB) affixed to the patientand position information relating to the surgical end-effector 112.

At block 2305, processor 2207 may control the robotic arm 104 (e.g., viasignaling transmitted/received through control interface 2205) to movethe surgical end-effector 112 to a target trajectory relative to theanatomical location of the patient based on the position informationgenerated using the sensor system. Moreover, processor 2207 may controlthe robotic arm to move the surgical end-effector to the targettrajectory responsive to receiving the user input to move the surgicalend-effector as discussed. Operations of blocks 2303 and 2305 may thuscontinue through block 2307 until the surgical end-effector until theend-effector is positioned in the target trajectory as long as the userinput to allow motion is maintained. If the user input to allow motionceases (e.g., the user's foot is removed from pedal 544) before reachingthe target trajectory, the robotic arm may be locked at blocks 2307 and2309 before reaching the target trajectory.

Once the surgical end-effector is positioned in the target trajectory,processor 2207 may receive user input through input interface 2201 tolock the position of the surgical end-effector at block 2307. Such inputmay be responsive to the user ceasing input that allows motion at block2307 (e.g., by removing the foot from foot pedal 544). Responsive tosuch input, processor 2207 may control the robot arm to lock a positionof the surgical end-effector at block 2309 (e.g., via control signalingtransmitted/received through control interface 2205).

While the position of the surgical end-effector is locked, processor2207 may continue receiving position information generated using thesensor system (e.g., camera system 200) remote from the robotic arm 104and remote from the patient. The position information may be receivedthrough input interface 2201. The position information may includeposition information relating to the tracking device (e.g., DRB) affixedto the patient and position information relating to the surgicalend-effector 112. At block 2313 with the position of the end-effectorlocked, processor 2207 may determine a deviation between an actualtrajectory of the surgical end-effector with respect to the anatomicallocation and a target trajectory of the surgical end-effector withrespect to the anatomical location, with the deviation being determinedbased on the positioning information generated using the sensor systemafter locking the position of the surgical end-effector.

At block 2315, processor 2207 may generate a user output indicating thedeviation, with the user output being generated responsive todetermining the deviation. The user output may be rendered as a graphicmeter on display 304, for example, using a display configuration asdiscussed above with respect to FIGS. 20A, 20B, and/or 20C. Moreover,the user output (e.g., graphic meter) may be updated dynamically toreflect changing deviations while the position of the surgicalend-effector is locked at blocks 2309, 2311, 2313, and 2315 (e.g., aslong as further input is not received at block 2321 to mode the surgicalend-effector.

According to some embodiments, determining the deviation at block 2313may include determining the deviation dynamically based on a model ofmovement of the anatomical location relative to the tracking device fora plurality of phases of a breathing cycle. The model may provide afirst offset (i.e., positional offset) of the anatomical locationrelative to the tracking device that is used to determine the targettrajectory for a first phase of a breathing cycle and a second offset(i.e., positional offset) of the anatomical location relative to thetracking device that is used to determine the target trajectory for asecond phase of the breathing cycle. Generating the user output may thusinclude generating the user output dynamically to indicate thedeviations based on the offsets for the plurality of phases of thebreathing cycle in real time. For example, a bellows belt may provideinput through input interface 2201 allowing processor 2207 to determinea phase of the patient's breathing (e.g., lungs inflated or lungsdeflated). Use of a bellows belt is discussed, for example, in U.S. Pat.No. 9,782,229, the disclosure of which is hereby incorporated herein inits entirety by reference.

Based on this breathing phase information, processor 2207 may use thefirst offset to determine a location of the anatomical location at afirst time during a first breathing phase (e.g., lungs inflated), andprocessor 2207 may use the second offset to determine a location of theanatomical location at a second time during a second breathing phase(e.g., lungs deflated). Processor 2207 may thus generate a firstdeviation at the first time at block 2313 based on the target trajectorydetermined using the first offset, processor 2207 may generate a seconddeviation at the second time at block 2313 based on the targettrajectory determined using the second offset, and processor 2207 maygenerate corresponding user outputs corresponding to the first andsecond deviations in real-time.

While the end-effector is locked in position, processor 2207 maydetermine if the deviation exceeds a threshold at block 2317. Responsiveto the deviation exceeding the threshold at block 2317, processor 2207may generate a user output to provide notification of excess deviationwhile the position of the surgical end-effector is locked. Suchnotification may be provide through output interface 2203 as an audibleoutput/warning using speaker 536 or as a visual output/warning usingdisplay 304. Such deviation exceeding the threshold may occur, forexample, if the patient moves or is moved on the operating table.Responsive to such a warning or for other reasons, the user may decideto reposition the surgical end-effector by providing input to move thesurgical end-effector at block 2321 (e.g., by pressing foot pedal 544).Responsive to receiving such user input through input interface 2201 atblock 2321 and responsive to receiving position information throughinput interface at block 2303, processor 2207 may control the roboticarm at block 2305 to move the surgical end-effector to the targettrajectory relative to the anatomical location of the patient based onsecond position information generated using the sensor system and asecond position of the tracking device.

According to some embodiments of FIG. 23, the surgical end-effector mayinclude a guide configured to guide placement of a surgical instrumentthat is manually inserted through the guide tube. Once the surgicalend-effector is locked and the user is satisfied with the placement, theuser may insert the surgical instrument through the guide to effect themedical procedure. The user, for example, may use the graphic meter todetermine that the end-effector is properly placed before executing theprocedure.

According to some other embodiments, processor 2207 may determine apattern of the deviation between the actual trajectory of the surgicalend-effector and the target trajectory of the surgical end-effectorbased on the positioning information generated using the sensor system.Such a pattern of deviation, for example, may occur due to breathingthat causes the anatomical location and the tracking device to movewhile the surgical end-effector is locked in place. Moreover, theend-effector may be a surgical instrument (e.g., a biopsy needle), andprocessor 2207 may control the end-effector to automatically deploy thesurgical instrument to effect physical contact with the anatomicallocation of the patient based on the pattern of the deviation (while theend-effector is locked in position). Stated in other words, processor2207 may choose a time of deployment to coincide with movement of theanatomical location that places the anatomical location in alignmentwith the surgical instrument of the locked end-effector.

Operations of a surgical robotic system (including a robotic armconfigured to position a surgical end-effector with respect to ananatomical location of a patient) will now be discussed with referenceto the flow chart of FIG. 24 according to some embodiments of inventiveconcepts. As discussed above, modules may be stored in memory 2209 ofFIG. 22, and these modules may provide instructions so that when theinstructions of a module are executed by processor 2207, processor 2207performs respective operations of the flow chart of FIG. 23.

At block 2401, processor 2207 may provide access to a model of movementof the anatomical location relative to a tracking device for a pluralityof phases of a breathing cycle for the patient. The model may provide aplurality of offsets of the anatomical location relative to the trackingdevice so that a respective one of the plurality of offsets isassociated with a respective one of the plurality of phases of thebreathing cycle. For example, the model may provide a first offset ofthe anatomical location relative to the tracking device with the firstoffset being used to determine the target trajectory for a first phaseof a breathing cycle (e.g., with lungs deflated as shown in FIG. 21A),and the model may include a second offset of the anatomical locationrelative to the tracking device with the second offset being used todetermine the target trajectory for a second phase of the breathingcycle (e.g., with the lungs inflated as shown in FIG. 21B). Moreover,respective offsets may be provided for any number of phases of thebreathing cycle, for example, including fully inflated, fully deflated,partially inflated/deflated, etc.

The model may be provided in controller memory 2209 or accessed frommemory and/or a database outside of the controller. The model may beprovided using a lookup table of breathing phases and respectiveoffsets, or the model may be provided as a mathematical relationshipbetween breathing phases and respective offsets. The model may bedeveloped before the procedure by taking medical images of theanatomical at the different phases of the breathing cycle while using abellows belt to detect the breathing phase. The medical images can thenbe used to determine the different offsets for the respective breathingphases.

At blocks 2405, 2407, 2409, and 2411, processor 2207 may performoperations of receiving position information, detecting breathing phase,and controlling the robotic arm to maintain the target trajectory untilthe procedure is complete at block 2411.

At block 2405, processor 2207 may receive position information generatedusing a sensor system remote from the robotic arm and remote from thepatient, and the position information may include information relatingto positions of the tracking device affixed to the patient and positionsof the surgical end-effector as the tracking device moves due to thepatient breathing.

At block 2407, processor 2207 may detect the plurality of phases of thebreathing cycle as the tracking device moves due to the patientbreathing. Processor 2207, for example, may detect the breathing phasesbased on information received from a bellows belt.

At block 2409, processor 2209 may control the robotic arm to maintainthe surgical end-effector at a target trajectory relative to theanatomical location of the patient as the tracking device moves due tothe patient breathing. The controlling may be based on receiving theposition information, detecting the plurality of phases, and using theplurality of offsets to determine locations of the anatomical locationas the tracking device moves due to the patient breathing.

By way of example, first position information may be received at block2405 and a first breathing phase may be detected at block 2407.Responsive to the first position information and detecting the firstbreathing phase, processor 2207 may control the robotic arm at block2409 to maintain the surgical end-effector at the target trajectoryrelative to the anatomical location of the patient based on the firstposition information generated using the sensor system and based onusing the first offset to determine a first location of the anatomicallocation from a first position of the tracking device responsive todetecting the first phase of the breathing cycle.

Provided that the procedure is continuing at block 2411, second positioninformation may be received at block 2405 and a second breathing phasemay be detected at block 2407. Responsive to the second positioninformation and detecting the second breathing phase, processor 2207 maycontrol the robotic arm at block 2409 to maintain the surgicalend-effector at the target trajectory relative to the anatomicallocation of the patient based on the second position informationgenerated using the sensor system and based on using the second offsetto determine a second location of the anatomical location from a secondposition of the tracking device responsive to detecting the second phaseof the breathing cycle.

While maintaining the end-effector in the target trajectory at blocks2405, 2407, 2409, and 2411, a medical procedure may be completedmanually or automatically. According to some embodiments, theend-effector may be a guide so that the user (e.g., a surgeon) canmanually insert a medical instrument through the guide while the guideis continuously and automatically maintained at the target trajectory tofacilitate a more accurate placement of the medical instrument over aperiod of time required to complete the procedure. According to someother embodiments, the end-effector may include a medical instrument(e.g., a biopsy needle) that can be deployed by the robotic systemautomatically while the end-effector is maintained at the targettrajectory.

In the above-description of various embodiments of present inventiveconcepts, it is to be understood that the terminology used herein is forthe purpose of describing particular embodiments only and is notintended to be limiting of present inventive concepts. Unless otherwisedefined, all terms (including technical and scientific terms) usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which present inventive concepts belong. It will befurther understood that terms, such as those defined in commonly useddictionaries, should be interpreted as having a meaning that isconsistent with their meaning in the context of this specification andthe relevant art and will not be interpreted in an idealized or overlyformal sense unless expressly so defined herein.

When an element is referred to as being “connected”, “coupled”,“responsive”, or variants thereof to another element, it can be directlyconnected, coupled, or responsive to the other element or interveningelements may be present. In contrast, when an element is referred to asbeing “directly connected”, “directly coupled”, “directly responsive”,or variants thereof to another element, there are no interveningelements present. Like numbers refer to like elements throughout.Furthermore, “coupled”, “connected”, “responsive”, or variants thereofas used herein may include wirelessly coupled, connected, or responsive.As used herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. Well-known functions or constructions may not be described indetail for brevity and/or clarity. The term “and/or” includes any andall combinations of one or more of the associated listed items.

It will be understood that although the terms first, second, third, etc.may be used herein to describe various elements/operations, theseelements/operations should not be limited by these terms. These termsare only used to distinguish one element/operation from anotherelement/operation. Thus a first element/operation in some embodimentscould be termed a second element/operation in other embodiments withoutdeparting from the teachings of present inventive concepts. The samereference numerals or the same reference designators denote the same orsimilar elements throughout the specification.

As used herein, the terms “comprise”, “comprising”, “comprises”,“include”, “including”, “includes”, “have”, “has”, “having”, or variantsthereof are open-ended, and include one or more stated features,integers, elements, steps, components or functions but does not precludethe presence or addition of one or more other features, integers,elements, steps, components, functions or groups thereof. Furthermore,as used herein, the common abbreviation “e.g.”, which derives from theLatin phrase “exempli gratia,” may be used to introduce or specify ageneral example or examples of a previously mentioned item, and is notintended to be limiting of such item. The common abbreviation “i.e.”,which derives from the Latin phrase “id est,” may be used to specify aparticular item from a more general recitation.

Example embodiments are described herein with reference to blockdiagrams and/or flowchart illustrations of computer-implemented methods,apparatus (systems and/or devices) and/or computer program products. Itis understood that a block of the block diagrams and/or flowchartillustrations, and combinations of blocks in the block diagrams and/orflowchart illustrations, can be implemented by computer programinstructions that are performed by one or more computer circuits. Thesecomputer program instructions may be provided to a processor circuit ofa general purpose computer circuit, special purpose computer circuit,and/or other programmable data processing circuit to produce a machine,such that the instructions, which execute via the processor of thecomputer and/or other programmable data processing apparatus, transformand control transistors, values stored in memory locations, and otherhardware components within such circuitry to implement thefunctions/acts specified in the block diagrams and/or flowchart block orblocks, and thereby create means (functionality) and/or structure forimplementing the functions/acts specified in the block diagrams and/orflowchart block(s).

These computer program instructions may also be stored in a tangiblecomputer-readable medium that can direct a computer or otherprogrammable data processing apparatus to function in a particularmanner, such that the instructions stored in the computer-readablemedium produce an article of manufacture including instructions whichimplement the functions/acts specified in the block diagrams and/orflowchart block or blocks. Accordingly, embodiments of present inventiveconcepts may be embodied in hardware and/or in software (includingfirmware, resident software, micro-code, etc.) that runs on a processorsuch as a digital signal processor, which may collectively be referredto as “circuitry,” “a module” or variants thereof.

It should also be noted that in some alternate implementations, thefunctions/acts noted in the blocks may occur out of the order noted inthe flowcharts. For example, two blocks shown in succession may in factbe executed substantially concurrently or the blocks may sometimes beexecuted in the reverse order, depending upon the functionality/actsinvolved. Moreover, the functionality of a given block of the flowchartsand/or block diagrams may be separated into multiple blocks and/or thefunctionality of two or more blocks of the flowcharts and/or blockdiagrams may be at least partially integrated. Finally, other blocks maybe added/inserted between the blocks that are illustrated, and/orblocks/operations may be omitted without departing from the scope ofinventive concepts. Moreover, although some of the diagrams includearrows on communication paths to show a primary direction ofcommunication, it is to be understood that communication may occur inthe opposite direction to the depicted arrows.

Although several embodiments of inventive concepts have been disclosedin the foregoing specification, it is understood that many modificationsand other embodiments of inventive concepts will come to mind to whichinventive concepts pertain, having the benefit of teachings presented inthe foregoing description and associated drawings. It is thus understoodthat inventive concepts are not limited to the specific embodimentsdisclosed hereinabove, and that many modifications and other embodimentsare intended to be included within the scope of the appended claims. Itis further envisioned that features from one embodiment may be combinedor used with the features from a different embodiment(s) describedherein. Moreover, although specific terms are employed herein, as wellas in the claims which follow, they are used only in a generic anddescriptive sense, and not for the purposes of limiting the describedinventive concepts, nor the claims which follow. The entire disclosureof each patent and patent publication cited herein is incorporated byreference herein in its entirety, as if each such patent or publicationwere individually incorporated by reference herein. Various featuresand/or potential advantages of inventive concepts are set forth in thefollowing claims.

What is claimed is:
 1. A method of operating a surgical robotic systemincluding a robotic arm configured to position a surgical end-effectorwith respect to an anatomical location of a patient, the methodcomprising: receiving position information generated using a sensorsystem remote from the robotic arm and remote from the patient, whereinthe position information includes position information relating to atracking device affixed to the patient and position information relatingto the surgical end-effector; controlling the robotic arm to move thesurgical end-effector to a target trajectory relative to the anatomicallocation of the patient based on the position information generatedusing the sensor system; after controlling the robotic arm to move tothe target trajectory relative to the anatomical location of thepatient, controlling the robotic arm to lock a position of the surgicalend-effector; while the position of the surgical end-effector is locked,determining a deviation between an actual trajectory of the surgicalend-effector with respect to the anatomical location and a targettrajectory of the surgical end-effector with respect to the anatomicallocation, wherein the deviation is determined based on the positioninginformation generated using the sensor system after locking the positionof the surgical end-effector; and generating a user output indicatingthe deviation, wherein the user output is generated responsive todetermining the deviation.
 2. The method of claim 1 further comprising:receiving user input to move the surgical end-effector to the targettrajectory relative to the anatomical location of the patient; whereincontrolling the robotic arm to move the surgical end-effector to thetarget trajectory comprises controlling the robotic arm to move thesurgical end-effector to the target trajectory responsive to receivingthe user input to move the surgical end-effector.
 3. The method of claim2, wherein the user input comprises first user input, the method furthercomprising: after controlling the robotic arm to move to the targettrajectory, receiving second user input to lock the position of thesurgical end-effector; wherein controlling the robotic arm to lock theposition of the surgical end-effector comprises controlling the roboticarm to lock the position of the surgical end-effector responsive toreceiving the second user input to lock the position of the surgicalend-effector.
 4. The method of claim 3, wherein controlling the roboticarm to move the surgical end-effector to the target trajectory comprisescontrolling the robotic arm to move the surgical end-effector to thetarget trajectory based on first position information generated usingthe sensor system and a first position of the tracking device, themethod further comprising: after generating the user output indicatingthe deviation, receiving third user input to move the surgicalend-effector to the target trajectory; and responsive to receiving thethird user input, controlling the robotic arm to move the surgicalend-effector to the target trajectory relative to the anatomicallocation of the patient based on second position information generatedusing the sensor system and a second position of the tracking device. 5.The method of claim 1, wherein generating a user output comprisesrendering the user output for presentation on a display.
 6. The methodof claim 5, wherein the user output is rendered as a graphic meter onthe display.
 7. The method of claim 6, wherein the graphic meter isupdated dynamically while the position of the surgical end-effector islocked.
 8. The method of claim 1 further comprising: generating a useroutput providing notification of excess deviation responsive to thedeviation exceeding a threshold while the position of the surgicalend-effector is locked.
 9. The method of claim 1 wherein the surgicalend-effector comprises a guide configured to guide placement of asurgical instrument that is manually inserted through the guide tube.10. The method of claim 1, wherein determining the deviation comprisesdetermining a pattern of the deviation between the actual trajectory ofthe surgical end-effector and the target trajectory of the surgicalend-effector based on the positioning information generated using thesensor system, and wherein the end-effector comprises a surgicalinstrument, the method further comprising: automatically deploying thesurgical instrument to effect physical contact with the anatomicallocation of the patient based on the pattern of the deviation.
 11. Themethod of claim 1, wherein determining the deviation comprisesdetermining the deviation dynamically based on a model of movement ofthe anatomical location relative to the tracking device for a pluralityof phases of a breathing cycle such that a first offset of theanatomical location relative to the tracking device is used to determinethe target trajectory for a first phase of a breathing cycle and asecond offset of the anatomical location relative to the tracking deviceis used to determine the target trajectory for a second phase of thebreathing cycle, and wherein generating the user output comprisesgenerating the user output dynamically to indicate the deviations basedthe model.
 12. A surgical robotic system comprising: a robotic armconfigured to position a surgical end-effector with respect to ananatomical location of a patient; and a controller coupled with therobotic arm, wherein the controller is configured to, receive positioninformation generated using a sensor system remote from the robotic armand remote from the patient, wherein the position information includesposition information relating to a tracking device affixed to thepatient and position information relating to the surgical end-effector,control the robotic arm to move the surgical end-effector to a targettrajectory relative to the anatomical location of the patient based onthe position information generated using the sensor system, control therobotic arm to lock a position of the surgical end-effector aftercontrolling the robotic arm to move to the target trajectory relative tothe anatomical location of the patient, determine a deviation between anactual trajectory of the surgical end-effector with respect to theanatomical location and a target trajectory of the surgical end-effectorwith respect to the anatomical location while the position of thesurgical end-effector is locked, wherein the deviation is determinedbased on the positioning information generated using the sensor systemafter locking the position of the surgical end-effector, and generate auser output indicating the deviation, wherein the user output isgenerated responsive to determining the deviation.
 13. The surgicalrobotic system of claim 12, wherein the controller is further configuredto, receive user input to move the surgical end-effector to the targettrajectory relative to the anatomical location of the patient; whereincontrolling the robotic arm to move the surgical end-effector to thetarget trajectory comprises controlling the robotic arm to move thesurgical end-effector to the target trajectory responsive to receivingthe user input to move the surgical end-effector.
 14. The surgicalrobotic system of claim 13, wherein the user input comprises first userinput, wherein the controller is further configured to, receive seconduser input to lock the position of the surgical end-effector aftercontrolling the robotic arm to move to the target trajectory; whereincontrolling the robotic arm to lock the position of the surgicalend-effector comprises controlling the robotic arm to lock the positionof the surgical end-effector responsive to receiving the second userinput to lock the position of the surgical end-effector.
 15. Thesurgical robotic system of claim 14, wherein controlling the robotic armto move the surgical end-effector to the target trajectory comprisescontrolling the robotic arm to move the surgical end-effector to thetarget trajectory based on first position information generated usingthe sensor system and a first position of the tracking device, whereinthe controller is further configured to, receive third user input tomove the surgical end-effector to the target trajectory after generatingthe user output indicating the deviation, and control the robotic arm tomove the surgical end-effector to the target trajectory relative to theanatomical location of the patient based on second position informationgenerated using the sensor system and a second position of the trackingdevice responsive to receiving the third user input.
 16. The surgicalrobotic system of claim 12, wherein determining the deviation comprisesdetermining a pattern of the deviation between the actual trajectory ofthe surgical end-effector and the target trajectory of the surgicalend-effector based on the positioning information generated using thesensor system, and wherein the end-effector comprises a surgicalinstrument, wherein the controller is further configured to,automatically deploy the surgical instrument to effect physical contactwith the anatomical location of the patient based on the pattern of thedeviation.
 17. A method of operating a surgical robotic system includinga robotic arm configured to position a surgical end-effector withrespect to an anatomical location of a patient, the method comprising:providing access to a model of movement of the anatomical locationrelative to a tracking device for a plurality of phases of a breathingcycle wherein the model provides a plurality of offsets of theanatomical location relative to the tracking device so that a respectiveone of the plurality of offsets is associated with a respective one ofthe plurality of phases of the breathing cycle; receiving positioninformation generated using a sensor system remote from the robotic armand remote from the patient, wherein the position information includesinformation relating to positions of the tracking device affixed to thepatient and positions of the surgical end-effector as the trackingdevice moves due to the patient breathing; detecting the plurality ofphases of the breathing cycle as the tracking device moves due to thepatient breathing; and controlling the robotic arm to maintain thesurgical end-effector at a target trajectory relative to the anatomicallocation of the patient as the tracking device moves due to the patientbreathing, wherein the controlling is based on receiving the positioninformation, detecting the plurality of phases, and using the pluralityof offsets to determine locations of the anatomical location as thetracking device moves due to the patient breathing.
 18. The method ofclaim 17, wherein the model provides a first offset of the anatomicallocation relative to the tracking device that is used to determine thetarget trajectory for a first phase of a breathing cycle and a secondoffset of the anatomical location relative to the tracking device thatis used to determine the target trajectory for a second phase of thebreathing cycle, wherein controlling the robotic arm comprises,controlling the robotic arm to maintain the surgical end-effector at thetarget trajectory relative to the anatomical location of the patientbased on first position information generated using a sensor system andbased on using the first offset to determine a first location of theanatomical location from a first position of the tracking deviceresponsive to detecting the first phase of the breathing cycle, andcontrolling the robotic arm to maintain the surgical end-effector at thetarget trajectory relative to the anatomical location of the patientbased on second position information generated using a sensor system andbased on using the second offset to determine a second location of theanatomical location from a second position of the tracking deviceresponsive to detecting the second phase of the breathing cycle.
 19. Asurgical robotic system comprising: a robotic arm configured to positiona surgical end-effector with respect to an anatomical location of apatient; and a controller coupled with the robotic arm, wherein thecontroller is configured to, provide access to a model of movement ofthe anatomical location relative to a tracking device for a plurality ofphases of a breathing cycle wherein the model provides a plurality ofoffsets of the anatomical location relative to the tracking device sothat a respective one of the plurality of offsets is associated with arespective one of the plurality of phases of the breathing cycle,receive position information generated using a sensor system remote fromthe robotic arm and remote from the patient, wherein the positioninformation includes information relating to positions of the trackingdevice affixed to the patient and positions of the surgical end-effectoras the tracking device moves due to the patient breathing, detect theplurality of phases of the breathing cycle as the tracking device movesdue to the patient breathing, and control the robotic arm to maintainthe surgical end-effector at a target trajectory relative to theanatomical location of the patient as the tracking device moves due tothe patient breathing, wherein the controlling is based on receiving theposition information, detecting the plurality of phases, and using theplurality of offsets to determine locations of the anatomical locationas the tracking device moves due to the patient breathing.
 20. Thesurgical robotic system of claim 19, wherein the model provides a firstoffset of the anatomical location relative to the tracking device thatis used to determine the target trajectory for a first phase of abreathing cycle and a second offset of the anatomical location relativeto the tracking device that is used to determine the target trajectoryfor a second phase of the breathing cycle, wherein controlling therobotic arm comprises, controlling the robotic arm to maintain thesurgical end-effector at the target trajectory relative to theanatomical location of the patient based on first position informationgenerated using a sensor system and based on using the first offset todetermine a first location of the anatomical location from a firstposition of the tracking device responsive to detecting the first phaseof the breathing cycle, and controlling the robotic arm to maintain thesurgical end-effector at the target trajectory relative to theanatomical location of the patient based on second position informationgenerated using a sensor system and based on using the second offset todetermine a second location of the anatomical location from a secondposition of the tracking device responsive to detecting the second phaseof the breathing cycle.